Various Listener Questions Regarding 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.

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 Lauro.

Steve Sedahl  00:37

Hey. Welcome in, everybody. This is Secure Money Health with Lisa Lauro. My name’s Steve Sedahl. Lisa is president of Secure Money Health, works in conjunction with Secure Money Advisors. They sound so nice together. She’s a licensed agent specializing in health insurance for folks like baby boomers, in retirees, getting ready to retire, getting ready for Medicare. That’s what we’re all about. Hey, Lisa, what’s going on?

Lisa Lauro  01:05

Good morning. How are you?

Steve Sedahl  01:08

I’m doing well. Thank you. It’s, it’s been a fun, fun week, and I think just going through all these questions, you know, you’re, you’re, you’re striking some chords with folks because they’re asking a lot of questions.

Lisa Lauro  01:18

Yeah, I guess. And you know what, I feel like I’m going to be in the hot seat today.

Steve Sedahl  01:25

Well, you are; no question about, because I’m not going to answer these, but we’ve got a wide variety. And again, some of these kind of surprised me and I guess, and then, on the other hand, some of them were, oh yeah, I understand that, right? So, did you see, let me, before we dig into all these, what, did anything really strike you as out of the ordinary? You don’t have to get into the questions, but…

Lisa Lauro  01:48

Yeah, no, I feel like, you know what? There was, you know, a few maybe that I was like, oh, okay, you know, because when you do this all the time, and I think this goes back to my teacher training, back in the day, you know people, what you think everybody knows isn’t always this, you know, isn’t always true. So, like, you know things that I might think are the obvious answer, or, you know, to a question isn’t obvious to most folks. So, and where that takes you back to teaching is you can’t always assume; you have to be thorough, and you have to, you know, make sure that you know you are teaching it as if it’s the first time for everybody

Steve Sedahl  02:29

Sure. Well, yeah, again, that’s a great point. And you know, when you’re doing something like you said every day, you just assume everybody must know these things. So not true, all right. Well, let’s jump in. Let’s see what we’ve got going on here. So here we’ve got a retiree in their late 70s, and they want to switch from Original Medicare to a Medicare Advantage plan with additional vision and dental coverage. They’re unsure about network limitations, out of pocket costs. How should they compare these options? Come on in and sit down and talk with you, I guess.

Lisa Lauro  02:58

Yeah, that’s a big one. So, so, you know, with the original Medicare, there’s a few things that are going to be very different for this individual once they make the switch over to an Advantage plan, because with Original Medicare paired with, let’s say, I’m assuming they have some type of Supplemental Medigap plan, right? Let’s just assume they have a G or an N or an F; but when they make that change, now they’re going to be subject to a network, right – whether it’s an HMO, a PPO – and so, you know, they’re going to need to definitely be mindful of which doctors they go to: are they in the network, especially if they’re on an HMO? And so that’s really, Steve, that’s where I come in with this amazing software. We’ve talked about it in previous shows, but, you know, I can put in the doctors that you have, and then the plans will show if they’re in the network or not. And then, you know, we can really curtail their plan choices to, based on their doctors, on their prescriptions, hospitals, urgent care. I mean, when people leave my office, I tell them exactly where they can go, where they can’t go. Sure, you know, I’ll print out a list if they need it. You know this, these are the urgent cares within 10 miles. These are the hospitals within 10 miles or 25 whatever you want. We can set the distance, but that’s going to be a really big thing for them: is making sure they know where to go, not to go. Now, the other thing is out of pocket costs. So, with these original Medicare paired with G or N or F, there is no max out of pocket. You’re paying a higher premium for those plans have a very small deductible, but then most of the costs are taken care of. You know, there’s not a lot of out of pocket costs with those plans, so that’s going to be a big switch for them as well, because with the Advantage plans you now have on average, a max out of pocket of, you know, in our local market here in Pittsburgh, you know, anywhere from 5 to 6,000 on average for the max. And so what that means is, and people confuse max with deductible; the max out of pocket is the most you would ever have to spend in a given year before the plan will pick up at 100% so it’s very important for folks making that switch to be mindful: of what are your co pays going to be? Because there will be co pays. A lot more co pays than what they’re used to on original Medicare. And so,

Steve Sedahl  05:38

Okay, and I understand the desire for vision and dental coverage. Are there other ways that you can accomplish that without having to go to an Advantage plan?

Lisa Lauro  05:45

Well, if you, yes, absolutely. So, if, if you are just in the hunt for dental vision, you know, searching for those, and you want to keep your original Medicare, that’s just a separate policy. So, you know, folks come to me all the time and say, “You know what? I have, you know, I have a Medigap Plan paired with my original Medicare, but I what I’m missing here, and I have a little bit of a gap here, and that’s my dental, my vision,” and some folks need hearing as well. And so, so that’s what we do. We look at all the plans that offer dental vision. Some are like a bundle. You can bundle them together, or if you just want dental and you don’t meet feel a need for the vision, then you don’t need to have that but, but, yeah, we can. You don’t have to switch to an Advantage plan just to be able to gain the benefits of dental and vision.

Steve Sedahl  06:33

Sounds like it’s a great opportunity to sit down and just figure out if it makes sense to switch

Lisa Lauro  06:38

Right, right. And that’s where you know, having a guide through this process is priceless, because, you know we don’t know what we don’t know, and, and, and that’s why I’m here to just basically hold your hand and go over it with you, and if it means that you know you’re staying right where you are. But we’re just going to add a dental vision plan. That’s one thing, if, if you like, all the extras that the Advantage plans offer, and over the counter. I mean, they talk to their friends often, and they, “Oh, I love my Advantage plan, and there’s lots of extras and a gym membership.” Well, if that speaks to you, that’s fine, too, but let’s, let’s talk about it first. Let’s make sure.

Steve Sedahl  07:11

Fair enough, give us a call. 724-293-6653. 724-293-6653, give us a call, and don’t forget, Lisa is also an author. Of course. She wrote The Ultimate Medicare Book alongside, well, Brian Quaranta and Right Track Your Retirement. I mean, again, the two books are, are very small, compact, but really good, and good to have on your bookshelf, I think.

Lisa Lauro  07:34

Yeah, thank you. Great resource.

Steve Sedahl  07:37

Yeah, and you can get it free. There’s no cost, and all you have to do is visit medicarebookoffer.com, medicarebookoffer.com, fill out the form, and Lisa is going to package up a book and send it to you. All right, let’s go on here. We’ve got a couple now with high medical expenses. What they’re wondering is if a Medicare Supplement or Medigap plan would cover out of, would help cover out of pocket costs. They’re looking at Plan G, but they’re concerned about premiums. How can they balance monthly premium costs against the potential savings?

Lisa Lauro  08:09

Oh, that’s a great question that’s loaded full of stuff here for us to answer. I can go so many different directions with this one, but so I guess you know, the couple with high medical expenses is wondering Medicare supplement plan would help cover out of pocket costs. So, the Supplement plan, and they’re specifically looking at G, there are no co pays with G, right? So, so if they’re going to the doctor, quite a lot, you know, on an Advantage plan, those, those costs are going to add up, right? Because there’s, there’s a lot of co pays everywhere you go with those, you know, so with the Plan G, there are no co pays. So that’s definitely going to cut costs for them. Now, I understand what they’re saying, because the cost, the premium, for a Plan G, is significantly higher than what you would pay for an Advantage plan. But if you get in the mindset of, you know, a pay it now, that’s your Medigap Plan G, you’re paying it higher, a higher premium now to have less cost throughout the year, because there’s no co pays, versus an Advantage plan, which is much lower in premium. But then you, you kind of get nickel and dimed along the way. So if you’re really one of those folks, you’re not, you’re not well, you go to the doctor quite often, and or you need, you know, MRIs, or whatever, then that’s, that’s something definitely to consider is, but I think it comes down to a little bit of number crunching, like, sit down with your, you know, all your expenses, you know, and then take a look. Now, the other issue with this is, is this, if they’re already on a Medicare Advantage plan and they want to switch to a Medigap supplement plan, there is an. Underwriting process that you have to health qualify in order to get approved for a Medigap Plan. So that’s the big thing. And I think people, people don’t realize that. So if they have not yet chosen, if they’re just turning 65 and they’re trying to make a choice initially, then perhaps they do go with a Medigap Plan, pay a little bit more in premium to not have that long term out of pocket cost, because when you first come onto Medicare, you’re considered a guaranteed issue. So they’re not going to look into your health history. There’s no such thing as pre existing conditions. But if you start on an Advantage plan first, and then later decide, “You know what, I think I need to be on the Medigap”, you may not pass the underwriting process. It’s much like life insurance. They go five, six years into your health history, they look at your medications that you’re taking, and you might be denied, and then you’re gonna stay on the Advantage side, so…

Steve Sedahl  11:02

So you’re not going to give up one before you get the other.

Lisa Lauro  11:05

Well, if it’s your initial, if it’s your initial choice-

Steve Sedahl  11:08

Yeah, then you can choose.

Lisa Lauro  11:09

Then you could, then you should probably, and you go to the doctors a lot, you have a lot of expenses, you should probably go with a Medigap to start, because you may not be able to get there later. It’s all going to be dependent upon your health.

Steve Sedahl  11:21

But by contrast, if I was on Medigap and I wanted to go to Advantage, that I can do. Is there an underwriting thing there too?

Lisa Lauro  11:27

Exactly. There is no underwriting. That’s a good point, Steve, I’m glad you mentioned it. So yes, if you’re on Medigap and want to go to an Advantage plan, you can do that with ease. There is no underwriting involved with that.

Steve Sedahl  11:39

Sure. Well, let’s talk about when, when we can make these changes. Obviously, there’s the open enrollment period, but then there are other exceptions throughout the year,

Lisa Lauro  11:47

Yeah. So, there’s annual enrollment, which is October 15 to December 7. And that’s really, you know, your Advantage folks are choosing a new plan. Okay? When you’re on a Medigap Plan, there’s no really enrollment period that you have to abide by, right? Unless you want to get off of it and go on to an Advantage plan at that time.

Steve Sedahl  12:09

Lisa, I need to look at the, I’ve got to pay attention the clock. Here we are about out of time for this segment. So, what I want to do is remind everyone to give us a call. 724-293-6653. 724-293-6653, sit down with Lisa. If you’ve got questions about Medicare, Medigap, just if you’re turning 65 and you’re saying, “Oh, it’s overwhelming.”, that’s why Lisa’s here. So, give her a call. Take advantage of this opportunity to sit down with her and work through it. 724-293-6653, 724-293-6653, quick break for us. We’re gonna come right back though. We’re gonna pick up some questions. Some questions about Medicare and more. When we come back right after this.

We are back on Secure Money Health Radio with Lisa Lauro. My name is Steve Sedahl, Lisa, president of Secure Money Health, and Lisa, I mean, I know we talked about this a few weeks ago, but you’ve got a teaching background. You spent, you know, a couple of decades teaching, so this is a logical move in my mind, anyway, to continue teaching, right? But it’s different. You’re still making a difference here.

Lisa Lauro  13:16

Exactly, and teaching has always been my passion. So, whether I’m, you know, with a bunch of kids or, you know, a different age group, that’s my heart. And so, I love sitting with folks. I love trying to problem solve with them and then teach them all about Medicare.

Steve Sedahl  13:32

Well, and the Medicare, I mean, there’s, it’s such a big deal, you know, I was talking with a friend of mine. He says, “Oh, I’m about a year and a half away. I can’t wait till I get to Medicare.” And it is a big deal, and it is something to look forward to, but it’s better to, you know, knowledge is power, like they say, and yes, you’re there to help us through that and understand that, yes, Medicare is a good thing. And let’s, let’s, let’s maximize it!

Lisa Lauro  13:54

Right, that’s the key, is maximizing your Medicare and your choices and making sure that you have, you know the best plan for you.

Steve Sedahl  14:02

Sure. All right. Well, here we go. Let’s jump into some of these questions here again. So, we’ve got a retiree with multiple prescriptions, and they’re worried about the Medicare Part D donut hole. They’re looking at prescription discount options or alternate plans to help cover the gap. What strategies could help them manage medication costs? I like it.

Lisa Lauro  14:21

Oh, that’s a good one. Well, the good news is, is that there is no more donut hole. As of 2025, they’ve done away with the donut hole, and they have now capped prescriptions at $2,000 per person. So, while that does sound like a lot, there are prescriptions out there that are, you know, $1,200, $1,500 every time you go and fill it. So, you know, a cap at $2,000 is much better than what it used to be with the donut hole. Now the only, the key thing here is that when you’re picking a prescription drug plan, you have to make sure that the medications are on the formulary, because if it’s not on their list or formulary, it’s not going to count towards the $2,000 cap. So that’s, that’s key, (S.S. Oh, I see.) And so, you know, what I do for my clients, we come in, they sit down, and we put everything in the software, and then the software will tell us if it’s on their formulary and exactly where it is on the formulary. What, because, because prescriptions are tiered one to five, one being your least expensive, all the way to five, which are specialty meds. So, the key is, as mentioned, is that you want to review and compare your prescription drugs every single year during the annual enrollment period. Okay, so that’s key. What you know what was on the formulary last year isn’t always going to be on the formula, formulary this year, so don’t assume; that’s key. Okay, that’s the first one. The next one is if you’re on an Advantage plan, or if you’re on a Medigap and you have a, what’s called a standalone prescription drug plan, and it’s just become too expensive for you, you may want to look at Advantage plans, because some Advantage plans offer additional drug coverage that could help reduce costs. So, if you’re just getting kind of boxed out and it’s just too expensive for you, you may want to consider making the switch to an Advantage. There are discount programs out there, programs like Good RX, Single Care, Well RX, they provide significant savings. You know, I think technically, you’re supposed to be using the plan for your prescriptions. But, you know, oftentimes the pharmacist, the pharmacist, sorry, oftentimes the pharmacist will, you know, run things through Good RX for a coupon as well.

Steve Sedahl  16:44

Okay. And so, that will work if you if, if you’re on a Supplement plan and or a drug plan. And so you can still try those, try to use those other things to knock the cost down?

Lisa Lauro  16:53

Yeah, yeah. And then, and then, of course, there’s also the LIS program, which is extra help for low income subsidy folks so that that they help with your prescription drug premiums and also deductibles and co pays. So, if you are a lower income person, then perhaps you want to consider applying for that. And I’m pretty sure you can go through the Medicaid for that.

Steve Sedahl  17:21

All right, fair enough. 724-293-6653. Now here we’ve got a retiree spending part of the year in another state – a Snowbird, I know – but anyway, they want to ensure they have coverage outside their primary residence. They’re considering Medicare Advantage, but they’re worried about network restrictions. What are their options for out-of-state coverage? That is a great question.

Lisa Lauro  17:42

It is, and it applies to so many folks who love to Snowbird. You know, I have two siblings. I have many siblings, but two of my siblings actually do Snowbird down in Florida and when they go, they take my mom, who’s 90, down to Florida with them, and they all are enjoying this lovely summer weather that they have. I talk to them all the time, and I’m oh so jealous, you know, but yes, so one thing to consider, if you are going to go live down somewhere warmer for the winter, you have to, if you’re on an Advantage plan, you cannot be out of your service area for more than six months. So, you want to be mindful of the time, because if you’re, if it’s longer than that, then you could lose your plan. So that’s key. The other thing is, you want to look at plans if you’re on… because this is this is this question really pertains more to folks that are on advantage, because if you have Original Medicare paired with G or N, you can see any doctor in the country that accepts Medicare. So, you have way more flexibility with the Medigap plans if you’re going to Snowbird, okay, so if you’re…

Steve Sedahl  18:55

So if you’re going to buy a motor home and travel the country, go with a Supplement.

Lisa Lauro  18:59

I would go with a Supplement. Yeah. So that’s one of the questions, when I sit with folks and they’re getting ready to retire, it’s like, are you planning on snowboarding, you know, because that’s going to help lead our, you know, choice one way or another in most cases. So, this really, this question really speaks to the Advantage folks. And so, one of the things that people are unaware of is, if you go with like a national company, oftentimes they’ll have a few plans that you can piggyback off the national network. So, meaning, if you are somewhere, you can call the member service number and say, you know – and these are PPO plans, not HMO. So, you definitely don’t want an HMO, because you can’t leave the plan service area. It’s not covered, okay, unless it’s an emergency situation or urgent care. That’s the two exceptions. So, you, so you definitely want a PPO, and then you want to see if you can pick a plan, because there are plans out there where you can use the national network. So, you want a carrier that’s nationally throughout the country and use their national network should you need to see a doctor. So, like, you know again, the emergency situation is different. But if you are down in Florida, and let’s say that you normally have a cardiologist up here, and then you want to go see somebody down there and establish a relationship for those five months or six months that you’re down there, you just want to make sure that you call Member Services and get on, you know, make sure you have a plan that you can use has that national reciprocity.

Steve Sedahl  20:35

Sure. Okay, I mean, though, but those are things that are not widely known. That’s why you’re here, Lisa, to just make sure that, you know, there are some there are some things that we can really do to that, you know. I think it’s like people just assume that they know, you know, like we were talking earlier, just assume they know stuff. But there’s so much to know here. We can’t know it all.

Lisa Lauro  20:53

Right, you can’t know it all and I even myself, I mean, I’ve, I learn new things every day, because it’s just, there’s some things that are just circumstantial to, you know, situations. And so, I, I’m always learning it’s, you know, yeah, it’s amazing.

Steve Sedahl  21:09

Yeah, it’s constant. It is good, yeah, 724-293-6653, and that’s the number you can call. So now let’s see. Here’s somebody turning 65, wondering if they need to enroll in Medicare Part B if they have coverage through a spouse’s employer plan. What are the rules around delaying Part B enrollment, and how can they avoid the late enrollment penalties? Yes.

Lisa Lauro  21:32

So, this is, this is key for folks that are you know, if you’re retired and your spouse is still working, or maybe you’re younger than 65 then, then you can, as long as your spouse has credible group coverage, you can go on their benefits until they’re ready to retire. Just the way that you go about applying for Medicare would be different later on, because you would be past your initial enrollment period, which is like a seven month period around your 65th birthday. So if you decide to defer your Part B you and your spouse has credible group coverage, you can go on their plan, and then when they’re ready to retire, you can both go on to Medicare at the same time. But the way you go about it, there’s some forms the HR department would have to fill out for you, and you just go about it a different way.

Steve Sedahl  22:29

Sure, but same rules apply, basically?

Lisa Lauro 22:33

Same what, in what regard?

Steve Sedahl  22:34

In, right, in regard to just getting onto Medicare. And you know, whether, what, no matter what we choose, if we’ve been on our, you know, employer, our spouse’s plan. So there’s no difference, but you said that it’s maybe outside the enrollment, which is that six months, seven month period.

Lisa Lauro  22:49

Yes so… yeah, yeah. So how you go about it is different, you know, in applying, but the same rules apply in terms of you would still be new to Medicare.

Steve Sedahl  22:56

Okay, all right, well, I’ll tell you what, boy this, this – we are nearly out of time again, and that means we’re going to have to wrap it up and say so long for this week. I want to remind everybody, 724-293-6653, is the number and 724-293-6653. Give Lisa a call. She’d love to sit down with you and walk through this Medicare maze. I mean, it’s, there’s, you know, there’s a lot of people out there that, that want to, that are selling Medicare on television. I’m just going to say that, every, you know, every, you know retired athlete, is out there pitching a Medicare program. Get with somebody like you, Lisa, who’s independent, who knows what’s going on, who can help us down that path called Medicare.

Lisa Lauro  23:38

Yeah, and the key thing, I know we have to wrap but, but you know the folks that when you call the 800 number, you’re never going to get that person on the phone again. You know, so when you have a question about billing or about doctors or about hospital, whatever your question may be, you want somebody local that you can call who’s going to pick up the phone and answer your questions.

Steve Sedahl  23:58

And that number to call, the 724-293-6653, Lisa is right here. When you go in and sit down, you’re going to talk to Lisa, right? You’re not going to talk to some, you know, somebody, or some random person in a phone room. That’s right, that’s right. All right, we got to wrap it up. This is fun show. I love this show. This, you know, it’s part of Secure Money Health, Secure Money Health Radio is what we call it, Lisa Lauro is here. She’s our Medicare expert, and we’re going to stay so long for this week, but hang on, we’ll be back next week with lots more Medicare information.

Speaker 3  24:28

Investment advisory services are offered through Foundation’s Investment Advisors LLC, an 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 expressed 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 herein. 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 1-800-Medicare to get information on all of your options. All rights reserved.

Outro  26:26

Coach P Radio.