Medicare Mistakes That Could Cost You Thousands 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.

Lisa Lauro  00:34

And we will really simplify the process.

Speaker 2  00:38

Welcome to Secure Health with Lisa Lauro.

Steve Sedahl  00:42

Welcome in, everyone. Secure Money Health Radio with Lisa Lauro, where Medicare matters. Lisa, how are you? Good to see you. This is a busy- I’m surprised you got any time at all to talk to me.

Lisa Lauro  01:11

I know, I know. I made sure I blocked this off. I wanted to definitely be a part of the show today, so I’m doing really well. How about yourself, Steve.

Steve Sedahl  01:20

Hanging in there. Yeah, absolutely. And this is it. We’re being inundated. The commercials have started the I did get my annual change from my provider, and so, you know, we’re rolling awesome when we get into things. I got a question for you too, but, but that’ll be later.

Lisa Lauro  01:37

Okay, no problem. Yes, it is annual enrollment, and we are just about getting into the thick of it. It’s an exciting time for us brokers out there, so we’re looking forward to it.

Steve Sedahl  01:50

Sure. Well, I like, I like this, this, it can be confusing. Got more options than a Cheesecake Factory menu, and that’s not far from the truth, and we got to do that. So, what’s actually changing this year. What? What’s the- what are some things that we need to be aware of?

Lisa Lauro  02:04

Yeah, so just from kind of reviewing some of- some of the plans and going to the meetings and stuff, a couple changes with Original Medicare, with Part B, pretty sure that the Part B premium is going to go up. They haven’t. It’s projected around 206, they have not released that data yet, so we’re not 100% sure, but they are expecting an increase in Part B the also with the prescription drug deductibles. I think they kept that out at 615 this year. So that’s gone up a little bit. I believe it was 585, or something like that last year. So that’s increased a little bit. They did increase the cap on the prescription drugs. So, this year, they introduced the- they did away with the donut hole this year, and they introduced a cap on prescription drugs. So long as your prescriptions on the formulary, and it’s covered, it would be capped at $2,000 a year, and that’s going up to 2100 so those are some 100 bucks. But what I am seeing, because I know, you know, we’re probably going to talk a little bit about Medicare Advantage plans, and this is the time where, you know, people are making changes to their to their plans. And one thing that I, that I have seen is, I’m, I’m feeling like a lot of the insurance carriers are kind of reeling things in on cost. I don’t know if those plans behind the scenes this, I’m not certain of it, just sort of my, my Inkling is perhaps, maybe those are pretty heavily subsidized, and I believe so. I think maybe they cut costs there and are trying to see what they can do now that they’re not getting as much money for the plans that they’re offering. And so, what I’ve seen across the board is every single carrier is handling things a little bit different. They all know they need to make some cuts. Some have made cuts to how much they’re offering on the allowance for dental, some have added a medical deductible, which we haven’t seen too frequently in the last few years. They you know, most of the Advantage plans had a zero medical deductible. So, I’m starting to see some plans introducing a medical deductible back again. Most of the plans have some type of a prescription deductible, like I mentioned, up to 615, Centers for Medicare Services also cut the healthy food allowance and made it more for folks that have a chronic condition. So, you know those food cards are limited to folks with special conditions now, where it used to just be, if you had that plan, you can get food right? So, didn’t realize that? Yeah. So, everybody, every, each of these insurance carriers. Have made changes to their plans. Along with introducing new plans, they have terminated Some. Some have been what’s called crosswalked, where they actually will say, Okay, we’re not going to offer this plan anymore. So, every single person that’s on this plan is going to that’s in this county will move over to this plan, and they call it a crosswalk. And so, we’re seeing some changes with that as well. I’m also seeing, like in the meetings, there was, like, a big push for HMOs over PPOs this year. And I think, again, it comes to cost. I think the PPOs allow folks to go out of network, and in doing so, it costs them more money. And so, there was a big push for HMOs. One of the one of the things that that folks are always concerned about, or kind of like they’re mostly concerned about, is the fact that they need a referral to usually with an HMO. And so, some of the plans are saying, Okay, if that’s the one thing that’s stopping you from getting an HMO, will you know you don’t need a referral for this particular plan. So that’s I’m starting to see a little bit more of that too. So, so many changes this year. Really an important, very important year for you to look at your annual Notice of Change. Did you see a lot of changes with your Steve?

Steve Sedahl  06:20

I noticed that they eliminated one county, like a big County, oh, wow, and, and then included a couple of others. So, I mean that, that, that I thought was Major, um, the allowance, you know, the- where you go buy, you know, over the counter kind of stuff, yes, right? They cut it down to 40 bucks a quarter.

Lisa Lauro  06:41

I saw big cuts there too, where, again, they’re trying to reel in a little bit, tighten their belts on what they’re offering. They still want to make it appealing at the end of the day, yeah, we know over 50% of Americans that are Medicare beneficiaries nationwide are on an advantage plan. So, pardon me. So, you know, they are still super popular, but I think this is the year where people are going to start seeing some changes, sure.

Steve Sedahl  07:08

Sure. So, that might make them go a different direction, right, right? But the beauty of working with you, Lisa is that if I’m on an advantage plan now, or if I’m on and I’m want to change, I can come in, sit down with you. So, you can say, Okay, this is your plan. Now, if you change, this is what happens, and here’s what it will cost. That’s the beauty of working with you, right?

Lisa Lauro  07:28

So, you know, you can get the letter in the mail, and that’s all well and good. It’ll highlight what you need, but it’s still not going to say, This is what your prescriptions are going to cost, or, you know, there’s certain specific details that you need that only, like you know, the software can help us with right adding absolutely about, you know, how much your prescriptions are going to cost and things like that. So that is the benefit of working with an agent and having someone you know, the this time of year, especially you see so many commercials with the 800 number to call in, call in, call in and you know, for folks that are stuck at home, maybe they’re not mobile, or whatever, it’s hard, and I can see why they would maybe take that opportunity to call. But you have to be kind of careful with that, because, you know, you’re, you’re, you’re, you’re probably going to not get somebody in the local market. So, you can be talking to someone in like, far away in a whole ‘nother state, about your Pittsburgh plans. And the downside to that is really just the fact that you don’t have someone to call when you have a question, because you’ll never get that person on the phone again. So, who are you going to call? Who’s going to be your point of reference? All of that really matters, so it’s, it’s good to establish a relationship with somebody local.

Steve Sedahl  08:46

Well, and again, you can start by doing by calling us right now. It’s 724-242-6828, 724-242-6828. All right, we’ve got some time. I’m going to tell you, because you were talking about changes. So, I had a situation where I my knee, what I’ve had trouble with in the past? Well, it blew up at the beach. I went into, you know, ortho, and they did the aspiration, and then she says, Well, I’ll give you cortisone, and I’ll keep doing that until you tell me you want a new knee. So now I need to sit down with Medicare and say, Okay, do I? Do? I go move from an advantage plan, which is sort of, you know, where you have a lot of a lot of co pays, as opposed to going to a different plan, you know, maybe traditional Medicare, where more of the operation will be covered, you know, more. But is that a, is that a typical sort of conversation you might have?

Lisa Lauro  09:38

So, you know that it’s so important that you brought that up. Actually, the thing here is when you want to change from like when you went on to your Medicare Advantage plan, you pretty much gave up Original Medicare to join the Medicare Advantage plan. Those are private insurance companies that are. Approved and under contract with Medicare, and they manage all of your care. So, you’re kind of like, you’re giving up the Original Medicare piece of that, and to want to return back to that is going to be an underwriting process that you have to go through, much like life insurance. So, you’re going to have to, you know, give them a history of your medical history, though, they’ll probably request your records. They’ll go look at all of your prescriptions, ask you about different chronic conditions that you may have, and things like that, and they may take you just depending on what your health history looks like.

Steve Sedahl  10:38

So that’s fairly typical, right? So that is very typical. But just for, just for clarity, I’m on a, on a PPO enhanced Blue Cross. I’ve actually got this blue bridge option where I can, without penalty, or anything else, go to traditional Medicare. Yeah, but I mean, obviously that’s a that’s a premium.

Lisa Lauro  11:00

Well, yeah, to have that, yes, yeah. So, I mean, I would look into it. They do have that and just depending sometimes when plans are terminated, you have that ability, if you stay with the same carrier. But I would look into it, you know, it will cost you a little bit more in premium, but at the end of the day, you know where, where surgeries become expensive. On the Medicare Advantage side, are really with the physical therapy, the follow-ups, because if you have to pay $30 for physical therapy three times a week for three months, that’s going to run you some money, so, it’s a give and a take.

Steve Sedahl  11:38

So, it’s a death by 1000 cuts, more or less. I mean, it’s not, it’s just a decision you have to make, right? And they just have to understand all the pieces of the puzzle. That’s where you come in. Thank goodness. 724-242-6828, and, you know, again. So just before we run out of time, any stealth changes that we should be looking at.

Lisa Lauro  11:59

Stealth changes. Woo, fancy word.

Steve Sedahl  12:03

Probably, I mean, again, it’s, I think you have to dig pretty deep, because, I mean, you know, yeah.

Lisa Lauro  12:10

I don’t really, I’m sure there are so, but they haven’t finalized a lot of this stuff yet. You know what I mean. So that’s exactly right, that’s the problem. So come December, we’ll have a better idea of because usually that’s when they release all the numbers from Centers for Medicare services and things like that. And so, we’ll have a better idea. But just yet, I’m not I’m not all that certain.

Steve Sedahl  12:31

All right, fair enough. We’ll leave it at that. If that all sounds overwhelming, truly, you’re not alone. And so again, sit down with Lisa. Take advantage of a review session, your Medicare review session, and again, she’s going to help you look at your current plan, compare what’s new, no pressure, no sales tactics, just good information, and it’s available by calling us right now. 724-242-6828, quick break. We’re back with more on the secure money health radio, where Medicare matters. We’re back on secure money health radio, where Medicare matters, with Lisa Lauro. Lisa, of course, is certainly has expertise in Medicare in all phases, so much so that she’s written a book. It’s called The Ultimate Medicare book, and you can get yours by visiting medicaresimpleguide.com, medicaresimpleguide.com she’s going to send you the book free of charge, no postage, no nothing, just, just the book and again, a solid, quick read. Lisa, tell me. Tell me about the book. Yeah.

Lisa Lauro  13:32

So, the book. I love the book for many different reasons. When I wrote it, I really thought about what are some of the things that people often question, right? What are things that they really need to know? And I think just having a teacher background for 20 years, I was able to write it in a way that I think is understandable for most people. So, I find that it’s, I feel that it’s a thorough, you know, super thorough in the chapters they there’s a lot about just a and b, what to be mindful of. There’s a whole chapter on Medicare Advantage, some things to look for in when picking one of those plans, things that you might want to be cautious of when picking those. You know, there’s ups and downs to everything. And then the same thing with the Medicare supplement plans, what to look for, what are some of the cautions, if there are any, and like, what that all looks like. There’s also a whole chapter on travel cruising, what that looks like with your health insurance, and how, what the coverage might be like for that. And then, of course, I think we end it with a whole chapter on the veterans and how this applies to them. So nice book. It’s an- it’s got a lot of really good information well.

Steve Sedahl  14:52

And again, you mentioned veterans, and I know that’s an important piece, and because they are, it’s different for vets in some ways, Medicare, isn’t it, especially if you’re covered under veterans, right?

Lisa Lauro  15:01

Right? It is different. You know, for those veterans that get their prescriptions from the VA, there are specific Medicare Advantage plans called ma only plans and it just stands for the M is, you know, it stands for Medicare Advantage only, meaning there’s no prescription drug piece to it. So, it’s a medical plan covers the hospital sometimes, sometimes, you know, a veteran might want to get a second opinion from a civilian doctor, and they can have that ability to do that with these plans. And then what’s nice about them also is that I know some of the VA benefits they I think they cover vision, but they don’t cover dental or vice versa. And so, with these Medicare Advantage only plans, they’ll have some dental benefits that they can use vision benefits to get some glasses if need be. And then the over the counter is one that people like which they get an allotment of money, just like the other advantage plans to use for things that they can use at the pharmacy. So, I think they’re really nice, well, put together plans. There’s also most of a lot of those plans have what’s called a part B, give back, and that’s where they’re giving them money back towards their Part B premium. And so, you can save money on your Part B by going with one of those plans. And that’s kind of a because they’re not using the prescription drug piece. They’re saving money on that plan. And so, they can give it back to them in that way. So, it’s really nice.

Steve Sedahl  16:39

Sure, folks, if you want to know some more, it’s 724-242-6828, or just visit medicaresimpleguide.com that’s where you can get the book free of charge. Medicaresimpleguide.com, make that call. So we were in the last segment, talking a little bit about Medicare Advantage and traditional Medicare and I put in a situation where, can you go from one to the other? And I guess the short answer is yes, but boy, there are some, some qualifiers.

Lisa Lauro  17:08

There, there are some qualifiers. So, what people you know, when you’re first turning 65, that first decision you make is important, because you’re in your open enrollment period, and you’re kind of like a guaranteed issue at that point. And so, you know, they’re not going to look into your health history at all. You’re going to get issued. And so, but if you choose the Medicare Advantage Plan, which many people do, like I said, over 50% of Medicare beneficiaries nationwide are on a Medicare Advantage plan in the Pittsburgh market, I would be like, I would say it’s more like I would say it’s more like 70% 75% Yeah. So, they’re very popular here. We’ve got really nice plans in our local area. But should you start on the Medicare Advantage plans and want to go back to a Medicare supplement plan later? It- there’s that underwriting there, and so it’s all going to be indicative of what your health looks like, because you have to health qualify to get back. But if you start with the Medicare supplement plans, like the Plan G or Plan N, those two are probably the ones that most folks go with when they choose a Medicare supplement plan. You can always switch over to the advantage side to Medicare Advantage. So that’s easy to do. That’s easy to do. There is no underwriting, no questions asked. You can switch right over now. If you want to go back to the other side again, you’re going to go through that underwriting. So, there is that underwriting piece, yeah.

Steve Sedahl  18:36

And so, what would make someone want to change?

Lisa Lauro  18:40

So, if you’re on there’s two reasons to change, to go either way, I would say, so let’s say you’re on an advantage plan. You are restricted to a network, and so maybe your life changes where you are now living somewhere else for four or five months out of the year, you’re snow birding, and maybe you want to have a set of doctors in your other location where you live. You may want to have the flexibility with the network for the Medicare supplement plans. You know there are no networks. You can see any doctor that accepts Medicare nationwide. So maybe your life changed, and you’re, you’re going to now be a snowbird, or maybe with the Advantage plans. Typically, the way these go is that, you know, the cost is very low for these. You know, it’s pretty cost effective. But then there are co pays, and those co pays can add up, and, and there’s a max out of pocket, which is kind of like a ceiling. So, if you all your co-pays add up and you hit that Max, then the plan will pick up at 100% but the maxes are, you know, sometimes 6, 7, 8, $1,000 so if you start getting really sick and you start hitting that. Max every year. It could be where you’re- it’s unaffordable, right? But the problem is, at that point, you can’t switch back if you’re very sick, because you’re not going to probably pass the health qualifications, the underwriting piece. But these are things, life changes. Yeah. Now if you start with a Medicare supplement plan, sometimes people want to make a change. There’s many different reasons. Sometimes people just don’t see the value in it, because it does cost more. And so, if they don’t feel like they’re getting because they’re relatively healthy and they don’t go to the doctor a lot, they don’t feel like they’re really getting their money’s worth. They might just want to switch to an advantage plan. I’ve heard people say that to me. I’ve also heard where people like with the Medicare supplement plans, there’s you have if you want dental and vision, it’s not covered, neither is prescription drugs. So those are all separate policies. Everything’s kind of a la carte. And so, if you wanted one of those, if you wanted those to be a part of your plan, you would more let- more than likely want to switch over to the advantage where those are usually offered. Not all plans have comprehensive dental and things, but there’s many to choose from. So, you can find one where you can have that. Or some people, it’s just as simple as they want the gym membership, sure.

Steve Sedahl  21:23

Well, yeah, that was a change for me this year as well. The last year was sort of a wide-open kind of a thing. And this year it’s, it’s Silver Sneakers and whatever that package includes, right? But so that was different.

Lisa Lauro  21:32

Yeah, yeah. So, um, so, lots of different reasons why people make changes. A lot of times it’s just personal stuff, you know, or circumstantial situations with a move or things like that. But there’s, I’ll tell you something, Steve, there is no right or wrong here. There isn’t, you know, it just comes down to what appeals most to you and what you feel most comfortable with that’s going because everybody’s health is different, everyone’s doctors, prescriptions, everything is you know, so you have to kind of make that decision based on what you feel is going to be the right choice for you, not your spouse, not your sister, not your brother, your mom, your dad, right? Because everybody’s different. Absolutely.

Steve Sedahl  22:14

I love this quote. When I turned 65, I thought I’d get a gold watch instead, I got a stack of Medicare brochures and a new best friend named Bart B. That’s hilarious.

Lisa Lauro  22:25

That’s a good one. Yes. Isn’t that the truth? Isn’t that the truth?

Steve Sedahl  22:30

Yes. So, I mean, the bottom line is, to me, it’s just so important right now, we’re, we’re in the- this is annual enrollment, not open enrollment, or am I backwards there?

Lisa Lauro  22:43

No, you have it right. This is the annual enrollment period.

Steve Sedahl  22:46

So, let’s- so what is open enrollment, then? Because that’s different.

Lisa Lauro  22:50

So, open enrollment happens in from January through March, and that is a special election period where folks that have a Medicare Advantage plan, who maybe either they didn’t make a change and now realize that their plan changed so they didn’t make a change now, this time of year, in the fall, and they need to make a change, or maybe they did make a change, and that plan isn’t working the way they thought It would, but it’s basically Medicare Advantage to Medicare Advantage. Those folks can make a change from January to March if-

Steve Sedahl  23:26

if, okay, that’s the change.

Lisa Lauro  23:29

Sometimes… You know, what I find, Steve, is that people have so many choices, and what happens is it almost creates like analysis paralysis, where they don’t, they’re him and they haw. And that’s natural. I mean, it’s human, it’s human nature, right? Sometimes too many choices is not good, right? But oftentimes, people will get stuck between two, and they’ll sign up for the one, and then they’ll end up, you know, one saying, You know what? That didn’t sit well with me. You know, maybe I should make a change to the other one is the one I probably should have chosen. These are people that don’t have the software, okay? And then they call me, and they go, Well, I did this. And now, you know, I and then they come see me, and we pull it up, and we really have, like, a whole analysis about these two plans. And then they realize that the other one was probably the better choice well.

Steve Sedahl  24:17

And again, it becomes so when you see it, it comes to life and you realize, oh, okay, this makes more sense for me. Like you said, there’s no wrong answer.

Lisa Lauro  24:25

I love that. Exactly, exactly. But

Steve Sedahl  24:29

But you’re there to help us along, to coach us, if you will. And folks, if you really want to get involved, give us a call. 724-242-6828, so if you’re not sure whether you should switch or stay Medicare checkup process that’s been sitting down with Lisa and going over all your Medicare, all your Medicare options, we’ll be we’re going to have to call this a show. Lisa, 724-242-6828, holy cow, this went fast. Let’s get together again next week.

Lisa Lauro  24:58

Sounds great. Thank you.

Speaker 3  25:00

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