Potential Penalties for Late Enrollment 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 1  00:34

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  00:38

And welcome in, everybody. This is Secure Money Health Radio, where Medicare matters. Lisa Lauro is here. She is our resident Medicare – can I say expert?

Lisa Lauro  00:54

I don’t know. There’s so many rules in Medicare.

Steve Sedahl  00:59

I know; well, but you’re really knowledgeable about Medicare, and especially when it comes to, you know, figuring out what’s what; what works for people. And I love what we were talking about last week when you say, Yeah, well, you know, you sit down with people and you lay it all out, and you give us options. And there may be, you know, there may be an option that says that Advantage is, it might work, but there’s another one says the Supplement might work. Right?

Lisa Lauro  01:23

Exactly. Yeah, it is so important that we are picking the right plan for you based on your personal needs and what’s affordable for you. So…

Steve Sedahl  01:35

So let’s get, so let’s remind folks that you are an author. You’ve written a book. It’s called The Ultimate Medicare Book, Simplifying Medicare So You Can Make Confident and Informed Decisions. You can visit medicaresimpleguide.com. medicaresimpleguide.com and get a copy of that book, and it will arrive in a beautiful gold envelope, and there’s no cost. You don’t have to pay for shipping, nothing. You’re just going to send out a book. If you visit that website.

Lisa Lauro  02:01

That’s right, medicaresimpleguide.com.

Steve Sedahl  02:05

Okay, medicaresimpleguide.com. The Ultimate Medicare Book. And I’ll tell you what, you’ve taken a pretty basic approach and taken things that are really complicated and just broken them down into something that that makes sense to us.

Lisa Lauro  02:19

Yeah. I mean, people really love my book for that reason, because it is a simple guide and my favorite part about the book is just – I mentioned pitfalls, which I think is important, because when you’re you know, you need to kind of know what, you know, what’s the downside of things too. You know, I like this plan. It seems great, or I like to go this direction, but what are some of the pitfalls that I might run into? And so we kind of play devil’s advocate on both sides of the road there with the Medigap and the Advantage plans and things just for you to be mindful of and look out for.

Steve Sedahl  02:56

Sure, absolutely, 724-293-6653, is the number. So let’s dig into some of these things. We’re talking about, what does Medicare cover? What doesn’t it cover? And we’ve talked about this, but the routine dental, vision and hearing not included in traditional Medicare.

Lisa Lauro  03:12

Right. So Original Medicare is more of a hospital and medical plan, and so your dental, you would have to get a separate policy, and I can help you with that as well. We have ancillary, you know, dental, vision policies that we can offer. And with those, you can do just dental, or you can bundle it together with vision and hearing. But you know what? What a lot of people don’t realize is that with dental plans, often, many of these dental plans that are available, you can’t file a claim on major work for 12 months. So it’s really, just will cover your preventative and it’ll cover some of the basic things, like fillings and extractions, but you might not be able to file a claim for a year. So, I do work with one specific one that you’re covered from day one. It’s 20% but it’s better than nothing. And so those are some of the things to look out for when you’re looking at dental. But there are lots of good options out there. And so if you’re on a Medigap Plan, G, N, F, whatever it might be. And you, you know they it doesn’t cover dental, vision or hearing, so you’re going to want a separate plan. It also does not cover the prescription drug plan either, and that’s a big one, whereby the dental and the vision, that’s not something. There’s no special enrollment period for that, there’s no penalty not to have it, but the Part D the prescription drug plan, there is a penalty. So even if you don’t take any prescription drugs, you’re definitely going to need some type of prescription drug plan to avoid a penalty.

Steve Sedahl  04:56

And again, those penalties are, we’re gonna talk about that in the next segment too. But, but again, so that is not included, but it can be, depending on how you put your plan together, physical therapy and rehab, they are, but there’s limits.

Lisa Lauro  05:11

Yes, there are limits to that. So physical therapy isn’t – it has to be deemed necessary by your doctor, right? So as long as your Part B will cover physical therapy if it’s deemed necessary, and there’s, but it’s, there’s a limitation to that as well. So you can only go for X amount of times, and then if you feel like you need, you’re not improving, you’re not showing improvement, then your doctor can send in for a pre-auth and see if you can get that extended. Sure. So there are some limitations with the physical therapy, but it is covered under Part B.

Steve Sedahl  05:55

And again, those are the things that, those are the pitfalls, if you will, that we’re, sitting down with you, we can avoid them, you know, and again. So when you when you look at medics, the open enrollment. That’s from, you know, October to December, a period of time in there, and that’s when we’re inundated with all the commercials on TV. And I think what sometimes people don’t realize is, if you call that number, not that there’s anything wrong with it, but you’re talking to a specific company, and then they are, they’re captured. They’re captive. They can only offer those products.

Lisa Lauro  06:27

Yes, so there’s, you know, if yes, if you call a specific, you know, 800 number, you could be calling a captive agent that can only offer you those plans. But you can also end up calling, you know, the 1-800 Medicare number, whatever it might be, and get someone that is, you know, not even in the local Pittsburgh market. You could be talking to a broker like myself, who’s licensed in all 50 states, and it’s just a call center. So, you know, random person is going to pick up the phone. They could be in, you know, Kentucky, right? Or Nebraska, or somewhere selling you a Pittsburgh plan. And honestly, while you know that might be convenient for you at the time it it’s going to poise a problem when, when you have a question, when you have a new medication, when you have a doctor, a new doctor, and you need to know if they’re in the network, if your medications are covered, what tier they are, how much you can expect to pay, who will you call then? You’re never going to get that person in Nebraska back on the phone again. We’ve talked about that before, but I can’t drive that home enough how important it is to have somebody in your local market Sure. Really try to avoid those 800 numbers, because those folks are not, their expertise isn’t in the Pittsburgh market, right?

Steve Sedahl  07:53

No, yeah, it’s limited. And that’s the beauty of working with Secure Money Advisors as well, and the team like Brian Quaranta. I mean, when you, when you call and say, I’m going to meet with Brian Quaranta, you’re going to meet with Brian and you’re going to meet with Lisa. I mean, that’s you’re going to see, Lisa’s who you’re going to sit with? Right,

Lisa Lauro  08:10

Right, right, exactly. Yeah.

Steve Sedahl  08:11

Well, one of the things, so we’re talking about what, some pitfalls to avoid, if you will, so and things that are covered, things that aren’t; so preventative screenings. They say it’s a silver lining. What does that mean?

Lisa Lauro  08:26

The silver lining. On the bright side, Medicare now covers more preventative servers… services than ever. So that is the nice thing, is that all preventative services, whether it’s mammograms, colonoscopies, PSA testing, you name it. It’s a huge list, and they are all covered by Original Medicare, which is your part. B.

Steve Sedahl  08:55

Right. Well, that’s fantastic that everything is covered. Is that, was there a time that some of those things weren’t covered, or covered 100%

Lisa Lauro  09:03

Yeah, maybe not covered 100% but as far as I’ve been doing this, it’s, they have been covered. But I guess, it’s part of an effort, really, to shift from sick care to health care. (I like it.) I know. I know that that’s one of the main things. Is that we’re really, if you’re up to date on your preventative screenings, we can catch things early, so we want to be proactive, not reactive.

Steve Sedahl  09:36

Yes. Oh, well said. And I mean that really makes so much sense to have it, to have it be that way.

Lisa Lauro  09:42

Yeah, yeah. And so definitely, if you haven’t gone for your preventative screenings, go ahead and go get those screenings done. Make sure you get your labs done. And make sure you’re ahead of the game.

Steve Sedahl  09:57

Well I’ll tell you, so I’m on an advantage plan. And. When you’re talking about preventative they’re very insistent that we get these well health checks. In other words, not my annual physical, that’s different. I get that, but you gotta have this wellness check, and you literally sit on the phone or in person and have this conversation about your health and your day to day, and that’s all they wanna do is just make sure that everything’s covered. I kind of like it, yeah, plus then you get a $50 gift card.

Lisa Lauro  10:26

Oh, well, yours is pretty generous with the gift cards. I mean, everybody’s different, right? But yeah, each company offers different things. But yes, I will be very honest with you, Steve, people either love it or hate it. Some people like yourself, they love it. They’re like, Hey, so what? I have somebody either come to my house or I talk to somebody over the phone, and they reward me for it. And what’s the worst that could happen? They’re just helping you right there. They could find something wrong. They could find something wrong, but, but there are others that come in and complain. They’re like, I don’t they keep calling me. I don’t want to be bothered. I see my PCP once a year. I’m good. And they, even though they’re rewarded with a gift card, they’re bothered by it.

Steve Sedahl  11:11

Oh yes, no, I get it. Feels invasive, I suppose.

Lisa Lauro  11:16

I guess. I mean what, you know, just tell them, you know, I’m not interested if that’s, if that’s the thing, right? So really nice. I’ll be honest, I think it is a really nice benefit. We’ve talked about my mom on the show a couple times, but you know, she’s coming 91 next week, and God bless her, she’s doing great. But you know, mentally, she’s great. Physically, she’s it’s hard for her to get around. She uses a walker. Sometimes she has to use her oxygen for her to get out of the house. It’s a lot so someone like her absolutely appreciates the home visit or the phone call going over her health and checking and making sure that’s something that she really admires about her plan.

Steve Sedahl  12:00

All right. Well, I like that. Let’s wrap it up for this segment, Lisa, and remind folks that everything is available for you right now. 724-293-6653, when you call you set up a time. Come on in, sit down with Lisa and map out your Medicare. And if you’re working with Secure Money Advisors, then just come on over when you’re done there and start talking about Medicare. We’ve got another segment to come. And we’ve got some, you know, some changes coming through Medicare, and some things that you might not be aware of that more when we come right back on the Secure Money Health Radio, Radio where Medicare matters with Lisa Lauro.

We are back on Secure Money Health Radio. It’s where Medicare matters. And I know for the most part, when you say Medicare and you think, eh, but I tell you what, once you get close to it, you want to know more about it. You need to know more about it. And I know, as I got closer, I just kept going. And then, and then it’s like I got excited because I was coming, you know, because I like it. I like being on Medicare.

Lisa Lauro  13:25

Yeah, yes, that is a lot of people love being on Medicare. They do. Because what folks don’t realize is Medicare is often the better choice over group insurance and 100% right? You could speak to that. But you know, and yes, I get it some, some plans are better than others, but in most cases, Medicare is the better option, and people don’t realize that until they go on to Medicare. There are folks out there that turn 65 and they remain on their group insurance. And I tell them, you know, you should really do a little bit of number crunching and at least consider Medicare. You know when you turn 65 because, you never know, it might be the better option for you.

Steve Sedahl  14:15

Well. And well, here’s the thing, too, if you don’t sign up when you by the time you’re 65 there’s a penalty, and if you don’t sign up, that penalty never goes away.

Lisa Lauro  14:26

Yeah, let’s talk about that, because that is really an important point to talk about. So, there are a couple different penalties. The first one we’re going to talk about is part B penalty. And so, you know, if you miss, you having a seven month Initial Enrollment Period. That seven months starts three months prior to your birth month. It includes your birth month, and then it goes three months after your birth month, and during that time you are supposed to sign up for your Part B. Now there are folks that. Decide to continue to work past the age of 65 and they, so long as you have credible group coverage – Now, what do they deem as credible? Right? Because that’s important. Yes, it has to be equal to or better than what Medicare has to offer, which is covering you medically at 80% you have to have Hospital Medical covering you at 80, at least 80% and then have a drug plan. Okay, so, and you can call your group insurance and find out if it’s creditable, and they’ll let you know. And you can even get a piece. They’ll sometimes even type up a letter that you can keep in your file to prove. Now here’s the flip side of that. Let’s say that you didn’t know that you had to sign up for Part B. Let’s say that you went through that seven months and you didn’t sign up for your Part B, and you don’t have insurance, you don’t have credible coverage, or you don’t have insurance at all. Well, in that case, if you’ve neglected to sign up for your Part B during that time frame, there is a 10% penalty for every year that you delay. So 10%, 10%, and that’s for life. So, with the standard Part B premium now at $185 a month, that penalty can really add up fast, and so, you know, if you’re coming on 65 in the next couple of months, sit – come in absolutely come see me. Let’s make sure you’re not going to face a penalty in the future. Make sure you do things correctly. We will guide you. It’s a complimentary visit and then this way you are not in this percentage of people that have a Part B penalty.

Steve Sedahl  16:50

We don’t want that. Well, there’s another penalty of, that can happen with Part D, and we’re talking the drug coverage now, right? The drug plan?

Lisa Lauro  16:57

Yes, Part D is your prescription drug plan.

Steve Sedahl  17:00

And so how does that work?

Lisa Lauro  17:02

Yeah, so Part D prescription drug plans come with its own separate penalty that’s different from the Part B, and the way they calculate that is 1% of the national base average, which this year, is roughly about $37 a month for prescription drug coverage. So 1% of the national base average times the number of months that you went without drug coverage? Wow, so. And then, whatever that adds up to be they tack that on to your prescription drug premium for the rest of your life. So, I had, I had somebody that came in, and at the time she turned 65 she didn’t have any medications, and so she thought to herself, well, that’s a waste of money. Why? Why would I sign up for a drug plan if I don’t take any prescriptions? Right? Right. Well, unbeknownst to her, she came to see me five years later, so 60 months right times 1% of the national base average. And she, in order for her to now sign up for a prescription drug plan, she got that, that in its income related monthly adjustment amount or whatever tax. Oh, no, pardon me, it’s not that. It’s just a tax, in general, a late fee. That’s the income – that’s a different one. But anyways, it’s a late fee. And she got that late fee and, and, you know, unfortunately, she had to deal with that for the rest of her life. And at this point she was, you know, 70, something, years old. And, well, yeah, and it was just a simple mistake. And I could see where people do, you know, hey, I don’t take prescriptions. Why do I need that? Well, you do, and you need it for two reasons. You need it because a you’re gonna, you’re gonna avoid a penalty. But you also need it because, what if we don’t know what tomorrow’s gonna bring? That’s right, you know, God forbid you get some terrible sickness, and now you need medications you never want to be caught without prescription drug coverage. It’s just not, not a good thing to do.

Steve Sedahl  19:07

Sure. Well, and so there’s this one we talked about this a little bit, but the credible coverage exception that that deals with working, that deals with working beyond 65 and then having that, that plan, your employer plan, maybe that’s good enough.

Lisa Lauro  19:23

Right, right. Yes, we did sort of touch on that. So yes, the creditable coverage exception is a lifesaver if you’re still working. So yeah, so if you’re if you do really like your employer plan, if it is suiting your needs, if it, if it’s not, if it is indeed the better choice over Medicare and you’re able to prove that it is creditable coverage, then you can remain on your plan until you decide to retire. And then how you go about applying for Part B would be different, because once you’re out of that seven-month initial enrollment window, applying for Part B is a little bit different. From there, you have a form that you need to have filled out by your HR or benefits coordinator at work, and then you apply for your Part B, and you use that form so that you don’t get the penalty. But, wow, that’s yeah, so lots of stuff, lots…

Steve Sedahl  20:13

Let me ask you this, yeah. So, have you worked with somebody? I mean, I’ve guess you have, worked with people that have been on their employer, and they’re beyond 65 and they come now to you and say, All right, how do we do this? Sounds like it can be complicated.

Lisa Lauro  20:26

Yeah. So, I see this all the time. I help people with it all the time, you know, we give we they give it. I always say, if you’re going to stay on your employer plan, that’s fine, if that’s what you think is best for you. When you’re ready to retire, start three months, you know, pick a definitive retirement date and work backwards three months. Give me a call. I will guide you through every step of the way. I’ll provide you with the form you need. I’ll tell you what to do with it. I’ll help you with your Part B enrollment, so that, you know, everything goes seamlessly, perfect. That’s, that’s what, what happens when you work with somebody that does this every single day, right?

Steve Sedahl  21:07

Right. Somebody that’s independent and knowledgeable, right?

Lisa Lauro  21:11

So, you know, that’s something that we really pride ourselves on, is, is, is amazing customer service. Really helping folks, taking all that stress and anxiety that comes with this big life changing decision, right? Yeah, taking that off of you, so that you leave, and you feel just really comfortable with where you are, comfortable with the path that we’ve sort of made for you in terms of which direction you’re going to go and, most importantly, your choice really will be effortless when you work with someone like myself.

Steve Sedahl  21:46

So there is a special enrollment period, and let’s talk about that for a second before we run out of time. I mean, again, it this one kind of confused me as I read through it.

Lisa Lauro  21:57

I’m not surprised. Not the first time I’ve heard Medicare confusing somebody, right?

Steve Sedahl  22:04

So, what are we talking about here, the special enrollment period. It says a grace period you don’t want to miss.

Lisa Lauro  22:09

Right, right. So, once you lose employer coverage. So, let’s just say that you went into work next Monday, and unfortunately, your job has been eliminated. You’re past the age of 65; you stayed on your employer coverage, and now you don’t have a job, and your health insurance is suddenly ending, right? That’s kind of what this speaks to. You have a, you are considered a special enrollment because you lost, the qualifying event here is that you’ve lost employer coverage, uh, however, the period of time of which you have to pick a plan and get on Medicare is important, so they’re giving you an eight month grace period to get your ducks in a row. Get your Medicare, get signed up for Medicare, get a plan in place and get enrolled, right, which some of that can take time. So, you have eight months to enroll in Part B without a penalty from the time, eight months, okay, yeah, and I believe it is eight months from the last day of employment or the last day of health insurance, whichever one comes first. Okay, okay, yeah, it could be different. And then, but here’s the twist. The twist here is that though you have eight months to enroll in Part B, you only have two months to pick up a prescription drug plan, so you still, and that, and missing, and we’ve talked about this, right, missing the Part D enrollment period could be very costly, so you want to be sure that if this happens, you call somebody like myself, a professional that can help you with these time frames to make sure that that you’re not going to make a mistake with this, because, sure, you know the times matter. You know what I mean? You’re really, there, there are these deadlines and they can be stressful. So, you know, be, just be mindful of that.

Steve Sedahl  24:13

And again, folks, if you want to know more, and if you want to sit down with Lisa; again, there’s no cost, there’s no obligation, you just have to just come on in, sit down and get some questions answered about Medicare. It’s a big decision, and it’s, it’s life changing, you know, because when you’re shifting from employer to, I mean, it’s a big deal. So call us a, 724-293-6653. 724-293-6653. Lisa, always a pleasure. These shows go by so quickly. But again, you know, as a guy on Medicare, I take notes all the time. I learn stuff every week.

Lisa Lauro  24:43

Good. I’m so happy to hear that hopefully you’re not the only one learning something new each week, but, (I hope so too.) Pleasure to be with you. Have a wonderful Saturday, and we’ll see you next week.

Speaker 2  24:59

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Outro  26:57

Coach P Radio.