Complexities of Medicare, Including Enrollment Periods 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, and we will really simplify the process. Welcome to Secure Health with Lisa.

Steve Sedahl  00:42

Welcome in, everyone. This is Secure Money Health radio with Lisa Lauro. It’s where Medicare matters. My name is Steve Sedahl coming up today. We’re going to dig into some pretty some interesting scenarios that people have gone through and Lisa’s helped them through. We’re going to have a creative Freelancer meets the Medicare maze. I like the Snowbird shuffle. We’re going to talk about that as well, and so much more. Lisa, hello. How are you?

Lisa Lauro  01:09

I’m good, doing well, yeah. How are you?

Steve Sedahl  01:12

Very, very well. Thanks. And, you know, we’ve got a lot to talk about. I like these, the situations where, where we actually, you know, look, look like real people. I mean, we’re making stuff up, but these are real scenarios that you’ve dealt with, right? Yes, and again. So, let’s talk about this. I mean, divorce and Medicare dependent. That’s, you know, great divorce that it’s certainly reality for a lot of folks. Let’s talk about, how does it work with Medicare?

Lisa Lauro  01:37

Yeah, you know. So, you know, folks that are divorced may still qualify to get the spousal benefits through Part B. I believe it’s as long as they haven’t remarried, okay, that they can still qualify and, and I’m not sure, it seems that there’s a certain amount of years that you have to be married, it may be 10, but I’m not 100% on that. Those are both really good questions for the Social Security Administration, but, but you can claim spousal benefits so long as you’ve had been married for a certain amount

Steve Sedahl  02:09

of time, I believe. All right. Again, sure. And folks, if that’s you, give us a call. It’s 724-293-6653, and this one the Snowbird shuffle, and there are so many snowbirds going from, you know, Philadelphia, down to Florida, down to Arizona, down to Southern California, wherever it might be, that’s where they go.

Lisa Lauro  02:30

Right, yeah. So, I do have a lot of snowbirds, yeah, especially since, since we live up here in northern PA, you know, we do have a lot of people that that snow bird. So, you know, network restrictions. So, this, this particular person had, it had an HMO and, and the HMO plan stands for health maintenance organization. It is a restricted network, and you can’t go out of network, okay, or you’re not covered. So, you know, it’s not if for somebody that I know is going to definitely be snowboarding, then I would, I would have steered away from the HMO. Okay, I did not put them on this. That something they had. And then we tried to remedy. How do we do this? How do we fix this for the annual enrollment period? Because you do get to pick a new plan every single year between October 15 and December 7. So, for them, the solution was, you know, the Medigap plans, they wouldn’t have health qualified to go through the underwriting. So that really wasn’t an option. So, we ended up going with a Medicare Advantage plan that was a PPO, which gives you a little more flexibility. And there are plans out there that are offered where you, if it’s you can, if it’s a national company, you can piggyback off the national network. Not all do that, but in their particular case, I was able to get them on a plan where they could use the national network. And definitely wanted to be on a PPO for that reason, so that this way they can call Member Services wherever they are, whether it’s Florida or, you know, wherever they Snowbird. And then they can call Member Services and say, I’m sick and I need to see a doctor. Can I see a doctor in the area? And can you tell me who I can see? And then they can guide them. So that is crucial. What they also didn’t realize is they picked up, initially, had picked up a Part D plan, and had to get rid of that as well. So, tell me about that. Yeah, Part D duplication is what, what, what they wrote in here, and so, so basically what happened was they, they didn’t realize that their original plan had a prescription drug coverage in it. So, they also got a Part D plan. And that’s a big problem, because those two do actually speak like where it behind the scenes in terms of Medicare. So, if you have an HMO with an advantage plan and then you pick up a Part D prescription drug plan, you’ll get kicked off the advantage plan. Oh, wow. So, you have to be very careful as to what you’re enrolling in, because you can end up losing your health insurance for that reason. Wow. So yeah, so you never want to do that. And again, if you’re if you find yourself that you’re mid- here we are. We’re midway through the year. There’s no enrollment periods coming up. But you know that the plan you’re in isn’t exactly the right plan for you. Just know that you’ve got that annual enrollment period coming up between October 15 and December 7. It’s a really wonderful opportunity to take a look at, a hard look at your plan and see if it’s you know, decide maybe you make a pros and cons list. You know what’s good about it and what don’t you like about it? Is there something that’s not working for you, especially as a snowbird. And how can we, how can we fix that?

Steve Sedahl  05:47

Sure, all right, well, and again, it’s you can fix it, folks by just giving Lisa a call. Right now. It’s 724-293-6653, Lisa also wrote a book. She wrote the book on Medicare, The Ultimate Medicare book, simplifying Medicare so you can make confident and informed decisions, which is fantastic. You can get your copy. It’s free. Medicarebookoffer.com just go to medicarebookoffer.com put a little information in, like your name and address, and Lisa will send that book to you and it’ll be there in a few days. You guys sent me that book like, boom, and I played along and it came.

Lisa Lauro  06:20

Oh, good. I’m glad, and I hope that you found it as a good resource for you. Well, Medicare, right? Like, you’re on Medicare.

Steve Sedahl  06:27

Yes, I’m on Medicare already, I get it, yeah, and it’s, but it’s, it’s, it’s very nice just to, just as a reference to think, well, what is that, or, and it’s not that I spend my days thinking about Medicare. I don’t, but there are things that come up, you know. Yeah, anyway, well, good, good, good. Let’s see how this one, a former IT pro, dives deep into plan comparison tools and finds flaws. Here’s, I’m guessing you’ve had people like this.

Lisa Lauro  06:54

Yeah, yeah. So, you know, I can’t say it’s a bad thing for people to do their own research, because it’s not, it’s good. It’s good for you to kind of do a little bit of homework before you come in. And then this way, the more you know, or feel like you know, or whatever you have questions, it leads to good questions, right? But, yeah, sometimes there are glitches within the quoting tools, we try to be as close as possible, I find that with prescription drugs. So, what we do is, here at the office, we have a software that we use. We enter in all your prescription drugs and dosage amount and how often you take it, and the plan will help us decide which plan is going to be right for you. Well, Medicare also has their version of that, which is medicare.gov, and sometimes their numbers are a little bit different than ours. And so then you say, Okay, well, which one is the trusted source, right? So, with these, you know, although we can make these, these quotes, we try to come as close as possible at the end of the day, it is our an estimation of what your drugs are going to cost when you get to the pharmacy. Usually, with the medicare.gov and my software, they’re pretty- they’re within a couple of dollars. It’s not like that big of a deal. But, you know, people, there’s a lot of people out there that will say, hey, you know, every little penny counts, so we need to be as close as possible. And you know, but those things do happen, networks, pharmacy, networks matter. You know, that’s another thing where quotes may be different, because maybe you did not put in a preferred pharmacy, so you do have to select pharmacies and so that might cause a discrepancy in cost. So if you have, if you have, if you’re looking, if you’re comparing different plans, and you have standard pharmacy for one and a preferred pharmacy for another, those quotes are going to be different, because standard pharmacies charge you more than a preferred pharmacy, those are the ones that are contracted with each individual carrier. So that’s where, where my knowledge comes in and say, Okay, well, we have a discrepancy here. Let’s see. Why is it? Is it because we’re looking at a standard versus a preferred pharmacy. Did you put in a brand name drug versus a generic? So, there’s little things that it makes a big difference. And sometimes, sometimes mail order, you can do better with a mail order than you can with an actual local pharmacy. Sometimes, if you don’t put in the right amount these software programs, if you put it in for 30 days versus 90 days, there might be a discrepancy there. So, there’s a lot of things that myself as the professional who does this all the time, looks at that the average consumer just doing this once or twice, may not know what- how to tweak it, yes and make it really give you the best estimate that’s as close as possible. So those are some of the causes of discrepancies that sometimes we do see Sure.

Steve Sedahl  09:57

And you know, in this case, he says he overlooked a couple of. Benefits, the over-the-counter benefit, and other and dental, that’s a huge thing to overlook. But I will say this about the OTC. I’ve got that it’s kind of cool. Get 100 bucks every quarter.

Lisa Lauro  10:10

Yeah, how can you beat it, right? I, you know, ironically, you would think, you know, hey, it’s free money, right? Like, go get whatever you need. I get complaints. People are like, annoyed by the over-the-counter benefit, and I just don’t understand it, why? And it’s because they say I have too much stuff. There’s I just can’t use it every month. I just I’ve gotten to a point where I’m on Medicare for three, four years now, I have had this advantage plan. They give me, they’re so generous, they give me a lot of money, and I’ve now have a stockpile of things that I need to use, and I think for some reason, it causes stress for people where, you know, I’m thinking, well, then if you can’t use it, then you can’t use it. That’s okay. Nobody’s, you know, nobody’s forcing you to, you know, make this order. But if you can, hey, it’s there for you. It’s a nice benefit to have.

Steve Sedahl  11:04

Well, it really is. And I’ll tell you, in my case, I’ve discovered some supplements that I just now don’t want to live without.

Lisa Lauro  11:10

Isn’t that amazing? Yeah, I mean, it’s all healthy stuff, and it’s like a risk-free way to try something new. And that’s exactly what I did, and I’m very happy, because vitamins are extremely costly. I was actually looking for a different vitamin just recently for myself, and I could not believe the cost of and gosh, I was thinking, Now, if I was on Medicare, I would have the over the counter and I’d be able to get this for free. But so, it really is. It’s a wonderful thing. And I love that you said that, Steve, that you, you know, why not try something new?

Steve Sedahl  11:45

That’s it. Well, yeah, why not? It’s money. I’m, you know, I’m on the plan. I’m paying a premium, you know. Okay, good.

Lisa Lauro  11:51

Yeah, try a new vitamin, try something different.

Steve Sedahl  11:55

And you might make a big difference in your life. It might, it might, makes a difference for me. You know.

Lisa Lauro  12:01

The whole, the whole thing, is that it’s, it’s not meant to stress anybody out and feel like they have to use this money or something’s gonna happen. It’s not meant for that. It’s meant to help alleviate cost, sure. So, take it for what it’s worth.

Steve Sedahl  12:15

And again, we’re gonna take a quick break Lisa, so we’re gonna again when we come back. We’ve got a couple of things, rural, retirement and Medicare Access. I like that because a lot of like that a lot. And then this one was a big deal, Medicare meets Medicaid. We’ll dig into that and so much more with Lisa Laura, where Medicare matters. 724-293-6653, 724-293-6653, that’s the number. Give us a call. We’d love to hear from you. We are going to take a quick break and we’ll come right back.

Welcome back, everybody. This is Secure Money Health radio, where Medicare matters. With Lisa Laura, Lisa has been helping folks you know, in the Medicare world, but you’ve been teaching forever, and I mean that in the kindest way that you know, that’s your passion, and it hasn’t grown. It’s still very much there for you.

Lisa Lauro  13:18

It is, it is. I love to teach, and I also love to learn new things. I just have this thirst for knowledge all the time. So, you know, like, I’ll like, see you don’t talk to somebody who’s doing a totally different job. You know, just having like, maybe I can, like, just take classes, just so I can learn about it. Like, I really enjoy learning new stuff, which is so cool, right, you know. But anyway, side note about me, that’s…

Steve Sedahl  13:44

That’s okay. I like it a lot. The- so let’s jump in here. We’ve got, this is interesting, because I know certainly there’s a lot of rural areas around you, around Pittsburgh, you go out there on the farmland, and, you know, people are 65 and they need Medicare too. Let’s talk about that. Is it different, or do we have to approach it differently?

Lisa Lauro  14:05

So, I would say, um, here in PA and especially in Pittsburgh, even the rural areas, they’re still, it’s not, it’s not as bad as what you would think.

Lisa Lauro  14:13

But what I hear-

Steve Sedahl  14:14

So, we’re not talking rural North Carolina, where I am.

Lisa Lauro  14:17

No, we’re not, however, however. I want you know we I do. I go to trainings every year. We go to big conferences, and we are always around different agents in different parts of the country. And what I will tell you is that I was surprised to find that the Medicare Advantage plans in rural parts of America are just not the same as what we have in Pittsburgh. We are so incredibly blessed the plans in rural parts of the country, most people go with a Medigap plan because they just- they don’t have and here’s the reason why they don’t have the competition that we have here in Pittsburgh. We have a lot of national companies all vying for a piece of the market. So, we people don’t realize, because, you know, no one else, people that are on Medicare here in Pittsburgh aren’t shopping for Medicare in the middle of, you know, wherever, right? Kansas. Okay, so they wouldn’t know. They wouldn’t know. They have no point of reference. But what I can tell you is that we are so blessed that we have these national companies all vying for a piece of the market. They are. These plans are very attractive with all the extra benefits that they’re giving. But there are parts of the country where they have one or two plans to choose from, and because they don’t have that that competition, they don’t have to go above and beyond. It is what it is, take it or leave it is sort of the mentality. So, I do feel for folks that are in these rural parts of the country where they don’t have a lot of options. Not only are the Advantage plans, you know, not as great, but they also don’t have options for facilities, doctors, hospitals, urgent cares. You know, in this scenario here, the specialist was 120 miles away. Could you imagine having to go see a cardiologist and driving two hours that might cause you to have heartburn? No kidding, right? You know what I mean? I mean that’s an issue, right? I can’t imagine. Now, telehealth has been a big thing for those folks. So that changes everything, doesn’t it? It does because you can jump on a zoom call with a doctor, you can get seen. I don’t, I mean, I’m not, I’m not a doctor. I just, I feel better going in and letting them see me, letting them feel the lump, or whatever the case may be. I feel like, how much can you really get done? But hey, listen, if, if, if it means that you have to have telehealth. It’s better than nothing in some of these rural parts. But yes, switching to a Medigap Plan is an option as well. When you go from advantage to Medigap, they do make it difficult. You do have an underwriting process, but with Medigap, the difference is that you can see any doctor that takes Medicare, so you’re not as the networks are not as restrictive in rural parts of America. That’s why most folks are on a Medigap Plan. Here in the local Pittsburgh market, 70, 80% of the local beneficiaries that are on Medicare, are on an advantage plan because of the choices we have. So, it is something to think about. It’s something to think about if you’re planning on moving. But yeah.

Steve Sedahl  17:31

So, I gotta ask you, this is random. So, do you watch the show, Pit?

Lisa Lauro  17:37

Pit?. I don’t.

Steve Sedahl  17:38

It’s all about Pittsburgh. It’s all about a hospital in Pittsburgh, yeah, Noah Wiley, oh, I’d highly recommend it. It’s, it’s-

Lisa Lauro  17:44

Get out of here. I know who Noah Wiley is. Yeah, right. He was, he was on, ER back in the day, wasn’t he? And that’s a great show. I’m aging myself, but yeah, that was a wonderful show when I was younger.

Steve Sedahl  17:54

Yeah, well, and it’s all, you know, it’s called Pit because there, and it’s, it’s one day in the emergency room, and the whole series this first season is one hour at a time, through the course of a day,

Lisa Lauro  18:05

And what channel?

Steve Sedahl  18:08

It’s on- uh- Max.

Lisa Lauro  18:11

Max, okay.

Steve Sehahl  18:12

HBO. Anyway, I just thought maybe because you were right there in Pittsburgh, well, maybe some of our listeners watch it. I’m sure they do, because it was, it’s a really strong show, emotional. I mean, I won’t lie, it brought me to tears more than once. Has it? That’s how powerful it is. Yeah, wow. All right, we will. Let’s move on. We digress. Got a little random there. This is a big deal too. And I know, I know my, my watch, my parents deal with this. Well, my mom in particular, with her mom, but Medicare meets Medicaid. Move that’s, I just don’t like the sound of that, but let’s, let’s talk about it.

Lisa Lauro  18:52

Yeah, so Medicare and Medicaid can be paired together if you are considered if you have limited income. Yes, okay, so you would apply for Medicaid, and then if you’re approved for Medicaid, there are specific plans that are Medicaid, Medicare, so you would have both. You would apply for Medicare and you would also see if you get approved for Medicaid. Now I’m not exactly I can’t remember what the limits were in terms of income, but it is for people that with limited income and so those are called Dual Special Needs Plans. And the Dual Special Needs Plans, okay, yeah, so the Dual is your Medicare and Medicaid combined and, and these plans have a lot of nice extra benefits. Sometimes they have a little bit more of the dental and the eye coverage and things like that. A lot of the extras are kind of boosted up. You know, sometimes folks that have limited. Added resources financially. Aren’t able to go to the dentist twice a year, as recommended. Aren’t able to get their eyes checked every single year. Maybe they have outdated glasses, you know, things like that that some of us take for granted. And so those plans are geared for those folks. It’s a wonderful thing that they have it available to them, and it’s based on your eligibility. Is there’s all different layers or levels of eligibility depending upon your income. Okay?

Steve Sedahl  20:35

And again. So then when I’m talking with Brian, and he talks talking about the spend down. If you’re going into Medicare or going into a facility, that whole spend down thing is kind of a scary process, isn’t it?

Lisa Lauro  20:49

Yeah, it is. And that’s the problem with, you know, like, Brian’s really good about taking care of his clients and making sure and planning for all of these things, because we don’t know what, what, what tomorrow is going to bring? Right? No, and we all, and one thing we do know is that, you know, facilities and long term care are very expensive, and long term care is not covered, so it’s something that you need to think about planning for and starting early with that, you know, but, but, yeah, so those are some, some of the nice options. There’s also, there’s also, what’s that fall in the same arena as Dual Special Needs Plans are they’re chronic Special Needs Plans, and those are called C Snips, and those plans are for people with chronic conditions. So, if you qualify for and what they deem as chronic, you know, like you’re a diabetic, you have congestive heart failure, you have COPD or some, you know, lung issues, pulmonary issues, I can’t think of any of the others, but those are the main ones, right? And those plans are geared for people with chronic conditions, and they have special attributes that that are geared for those folks as well. So, lots of things to think about, right?

Steve Sedahl  21:59

Oh my gosh, I guess so. But again, the- to me, the best part is that you’re here, you’re a phone call away. You’re happy to talk about Medicare, if you’ve if you’re working with Brian and the team over at Secure Money, or Secure at Money Advisors, you know, then you owe it to yourself to call Lisa and come on in and get the Medicare piece. And I know, you know, I’ve worked with Brian for years now, and, you know, watched him build this business that he’s done and create this one stop shop. It’s pretty amazing. And again, what a great thing for people.

Lisa Lauro  22:28

Yeah, and it goes both ways. I mean, I highly encourage my clients to see Brian as well. So, if you know, if they come see me first, you know, there’s a lot of tax planning that has to be done. Not everybody has a plan for that, especially when you’re coming on to Medicare so that you don’t get hit with these Irma charges later. So that’s a big deal, right? Like we talked about in a previous segment, but, but yeah, so. So, for those folks that aren’t currently working with a financial advisor, someone who can help you retire and do it correctly, I highly, highly suggest that they go see Brian as well at Secure Money Advisors.

Steve Sedahl  23:13

All right, but in the meantime, you give Lisa call, 724-293-6653, 724-293-6653, you can also learn more at Secure Money Advisors and securemoneyhealth.com that’s the website where you can go and really see kind of what you do and what’s available and some of your processes. It’s fairly well laid out, I think.

Lisa Lauro  23:36

Well, thank you. Yeah, securemoneyhealth.com it’s a wealth of information, a lot of basic stuff about Medicare. But I think you can also get my book offer there. If not, you can always go to what, medicarebookoffer.com?

Steve Sedahl  23:53

Yes, yep. Well, all right, Lisa, we’re going to have to wrap it up. This has been, again, these shows go by so quickly, but great information, and I love how they just kind of all fall together.

Lisa Lauro  24:02

Yeah, it does. It all sort of is connected one way or another, and so it flows nicely, doesn’t it?

Steve Sedahl  24:08

Absolutely. Well, hey, we’ll do it again next week. How about it?

Lisa Lauro  24:11

That sounds great. Enjoy your week.

Speaker 2  24:20

Investment advisory services are offered through foundations investment advisors, LLC and 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 express 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 here and 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 one 800 Medicare to get information on all of your options. All rights reserved.

Outro  26:22

Coach P Radio.