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What is Medicare?

Hi, Welcome to Caregiver cast. My name is Mary Elaine Petrucci, your host. My special guest today is Marty Silbernik, and he will be talking to us about Medicare.

I know that there’s been a lot of changes in Medicare, a lot of advertising on TV. So, I have Marty here to give us exactly what’s going on with Medicare at this point. Before I formally introduce Marty, I’m going to just read some information about him. Marty is a native Chicagoan, who began his career in marketing for one of the largest restaurant companies- McDonald’s, over 21 years at the corporate level, he helped the company grow from some 2300 restaurants, to over 23,000 restaurants. Pretty impressive!

Marty: Thank you. 

Mary: In the mid 90s, Marty left Chicago and moved to South Florida, purchasing to Mc Donal restaurants in Broward County. Sometime 10 years later, he left the McDonald’s family and opened a couple of small sandwich shops also in Broward, when the real estate market collapsed in the late 2000s. He left the restaurant industry after more than 30 years and embarked on a new career in Insurance. His initial focus was on indemnity insurance, like accident, disability critical illness programs that were used for voluntary employee benefits. These routes are still part of the overall services he provides but the natural offshoot of that was to expand into Medicare.

Over the last 12 plus years, he’s brought his enthusiasm for customer client service and helping people to the Medicare arena. Marty is with United experts in Boca Raton, Florida. He offers Medicare Supplements, Advantage plans and drug plans from all the major players in the Medicare industry, such as United Healthcare, United American, Humana, Aetna, Mutual of Omaha, and WellCare. His primary focus is to educate his Medicare beneficiaries so they can make an informed decision that best serves their long term needs, protecting their health for years to come.

Welcome to Caregiver cast. Marty, how are you? 

Marty: I’m wonderful. It’s my absolute pleasure to be here with you today, Mary Elaine.

Mary: It seems like you have been really busy with licenses in 22 states.

So it’s pretty impressive.

So I feel honored that you’re here. So let’s just start with the basics. Because I know people are really confused about Medicare.

It seems to get more complicated year after year. So can you tell us how someone can enroll in Medicare? 

Marty: Sure. You mentioned a very interesting thing. On my normal zoom calls, when I do networking. I have a banner over my head that says “Everybody knows what Medicare is, but very few people understand it”. So that that’s really my that’s really my thing and that my focus has become on educating people on Medicare, and if I educate obviously will make the right decisions. So to answer your question, how do you enroll in Medicare? It’s really very simple.

If you’re already collecting Social Security, let’s say you say that you started to collect early, you’ll automatically be enrolled in Medicare, you’ll get a Medicare card, it’ll have your dates, everything under the sun.  If you’re working and you’re going to continue working after you’re 65 and you have outstanding employer coverage, you don’t need to enroll in Medicare. But I do recommend that you enroll in Medicare Part A because it doesn’t cost anything. And that way you have the ball rolling, doing that is very simple. You can do it online, go to ssa.gov, which is the Social Security Administration’s website.

Under the Apply for Benefits category, you’ll see enroll in Medicare. And then you can enroll in Medicare Part A Part B. Now, I fall into the senior category. So I’m going to say this a little bit.

I don’t know what the word is with some seniors aren’t comfortable with technology.

So, or you can always call the local Social Security office or the National Social Security number and tell them. Hey, guys, I want to enroll in Medicare, and you can do it over the phone. So it’s that easy. 

Mary: Okay, great. That seems nice. I wish you had the banner, because that is so true. So how, what are some of the misconceptions about Medicare what they can and can’t insure you for? 

Marty: That’s a great question. There’s a lot of confusion about what Medicare does cover and what it doesn’t cover. Let’s let me start real simply with what it doesn’t cover, that people think it should.

Medicare does not cover long term care, you have to have a separate long term care policy. There is no provision for that. And Medicare, there’s a limited provision in Medicaid. 

Mary: Okay, 

Marty: So Medicare does not cover. And this has been a big thing in the last several months dental, vision or hearing. 

Mary: Right!

Marty: As a standard coverage, it’s not covered the build a better American plan, or however they’re they are phrasing the term with what’s going on in Washington originally had, and we were excited about it coverage for dental, vision and hearing comparable to what Medicare covers for health care.

But that got knocked out in the negotiations between the administration and the Congress and the bill that was signed the other day had no coverage for Medicare. So that’s one of the myths. Another myth, is that it’s hard to get help with Medicare plan. Everybody has to be confused, I have to listen to TV, I have to listen to the phone calls they can. That’s not true! There’s some great resources to help you understand Medicare, first and foremost is medicare.gov. Anything you would want to know about Medicare as answered on their site. Now, you have to do a little bit of digging, but everything is there. Number two, there’s people like me, there are people who are, and I won’t say salesman, because I hate that word, because I don’t sell Medicare. But there are people who represent a number of Medicare plans as I do, you mentioned all the companies, so I won’t go through that again. But as an independent agent, my job is to work with my clients with a Medicare beneficiary, and help them understand all of the options that are out there to take the time to explain them, tell them pros and cons and help them make an informed decision about their coverage. So, there’s help out there, you just have to find the right resource and find, the right person, somebody you feel comfortable with somebody you can build a relationship with. Because a decent agent, a good agent will become your advocate as well. So you want to make sure you have somebody you can trust. 

Next thing is – Medicare is the same for everybody, I sign up for Medicare, I get my card, I go to the doctor, and I’m done. That is absolutely not true. Medicare has to be, I look at Medicare has a custom tailor you, you can go to Walmart or Target or Macy’s and buy a suit off the rack or go to a fine custom tailor and have a suit custom made to fit you perfectly. In the Medicare world, it’s important that you take the time to custom tailor that plan. Just because your brother in law or your neighbor has the best Medicare plan in the world doesn’t mean it’s the right plan for you. That person may have different doctors, they may have different health care issues, they may have different prescriptions, they may have a whole host of things that are different from what you have. And while their plan addresses their needs. Their plan may not address yours. So, you really have to, you really have to be careful, it isn’t customed tailored.

One more myth about Medicare, it’s only for low income people. It’s not, it’s for everybody who turned 65 everybody in their working life has paid into Medicare and everybody is eligible for it. Now, that said, if you’re a high income individual, you’re going to pay more for your Medicare, you’re going to pay a higher Medicare Part B premium. There’s a sliding scale for 2022 that goes anywhere from $170.10 a month for your Medicare Part B premium, up to $519. So, high income people pay more, but they’re eligible for it. So, those are some of the common myths.

I mean, there’s a whole host of misinformation floating around the marketplace. It’s hard to address them all in a short time like this, but those are the pretty big ones that people just don’t understand more often than not. 

Mary: Okay, thank you very much for explaining that. So, just to kind of reiterate, Medicare does not cover dental, vision or hearing correct

Marty: Traditional Medicare.

Mary: Thank you. It doesn’t cover long term care. It doesn’t help with every all your medical problems necessarily correct.

Marty: It pretty much covers the Oh, again, it depends on the plan that you’re on and the coverage that you elect. But he covers the overwhelming majority of the healthcare needs of most people.

There, there are certain elective procedures that may not be covered. But for long term health care, they’re pretty well covered under Medicare. 

Mary: Okay, thank you. We’re in the Annual Enrollment period, correct? 

Marty: Yes, we are. 

Mary: Yes, we are. And, so what’s the difference between the Medicare Annual Enrollment period from September to early December, and the open enrollment period?

Marty: That that’s an interesting one, the annual enrollment period, and we’re in the middle of that right now goes from October 15 through December 7 every year. 

Mary: Okay

Marty: That’s when anybody can transition from Original Medicare to Medicare Advantage plans to transition from Medicare Advantage Plans back to original Medicare, which from one Medicare Advantage plan to another Medicare Advantage plan, switch from one prescription drug plan to another prescription drug plan. It’s the time period where you can make all the major changes to your Medicare coverage. My recommendation to all of my clients and to anybody I talked to, is you need to review your Medicare every year during annual enrollment and you need to deal it with somebody who knows what they’re doing because just I’ll just use my example right now. Since October 15 and my client base, I probably saved my existing clients, somewhere to the tune of around $20,000 in costs that they would have incurred if they not made a change to their coverage. 

Mary: Wow! 

Marty: Pretty large client base, but that’s still a lot of money. So it’s really important for those people who have never evaluated or reviewed their Medicare coverage. It’s absolutely critical. I have a client who hadn’t reviewed her coverage for 18 years.

18 years, she just let it ride. 

Mary: Wow! 

Marty: The coverage I saved for over $5,000 a year in prescription drug costs. 

Mary: Wow! That is amazing! 

Marty: So, Annual Enrollment period is really important. Now, and this is where it gets confusing, because we’re in the middle of also traditional health care open enrollment but there’s a separate Medicare Open Enrollment Period. That’s the first quarter of every year January 1 through March 31. They call it open enrollment. I have a different name for it. “It’s the- oh my god! I screwed up my coverage and I need to fix it period”. One time opportunity in the first quarter of every year, let’s state with a Medicare Advantage plan. 

Mary: Okay,

Marty: It’s strictly for Medicare Advantage plans, no other Medicare coverage and you got your plan and on January 15, you went to see your doctor and the doctor says, “Well, you know, something, Mary Elaine, we don’t accept that plan anymore” and you’ve been with his doctor for 30 years and you want to stay with his doctor. 

Pick up the phone, you say, Marty, “I just went to my doctor and he’s not accepting my plan. What can we do?” We’re going to find a plan that your doctor accepts and you have a one-time opportunity during that open enrollment period and every year to switch to a new plan or another plan. 

Mary: Okay. And that only happens with the Medicare Advantage plans. Oh my right. Okay. 

Marty: Let me qualify something else. Medicare supplements can be changed anytime during the year. They’re not restricted to the official enrollment periods. So you have more flexibility there but with Medicare Advantage, that’s your options. 

Mary: Okay. Thank you! So, you just mentioned how you can change your Medicare plan if you have a Medicare Advantage plan. So, what’s the difference between the Medicare Advantage plans and the Medicare supplement plans? Why do you need them? 

Marty: Well, that’s a good question. You can have either a Medicare supplement or a Medicare Advantage plan. You can’t have them both. Okay! Medicare supplement is what’s called Original Medicare. You have Part A Medicare Part A which covers hospitalization, Medicare Part B which covers doctors, outpatient, quite a few other things. Durable Medical Equipment anything other than hospitalization with the exception of prescription drugs. Now Original Medicare and Medicare supplements do not cover dental vision, or hearing!

Mary: Okay

Marty: A Medicare supplement is designed to cover the 20% of Part B costs. And the Part A deductibles that would normally come out of pocket a monthly premium, the 20% or all the costs that Part A and Part B would normally transition to you are covered under a supplement. 

Mary: Okay

Marty: With that, once you’re done with your annual Medicare Part B deductible, which in 2022 is going to be $233. All you do is pay your premium, you never see a bill from your doctor, you never see a bill from a hospital, you never see a bill from an outpatient clinic, you got you have 100% coverage. Okay! Together with that, you need to have a prescription drug plan. Those can run anywhere from I’ve seen them run anywhere from $7 a month to $101 a month. And it all depends on the prescriptions that you have the drugs that you need to take. And the area that you live in. Everything on Medicare is geography based. So we we’re going to qualify that as well. So, that’s Original Medicare with a supplement. Medicare Advantage is a plan that combined all of that into a single plan, hospital doctor, prescription drug, it has very limited dental, vision and hearing benefits. It often times he has some over the counter benefits, all the things you see in the television commercials that are going on right now.

Okay, I see Joe Nemeth all the time, I see Joe Montana has a one year plan throwing letters into the bin and it was his plan. Medicare Advantage plans are true managed care, they more often than not are HMO – health maintenance organizations- you’re limited to the network that the particular company has available to you, you will need to deal with primary care physician and any referrals to a specialist will have to go through that primary care physician. Any procedures, or most procedures that the specialist or the PCP would like to do, will have to get prior authorization from the insurance company and it really does limit your ability – Original Medicare let you go anywhere in the US. Most Medicare Advantage plans are geographically based, they oftentimes most of the major players have availability for you in other areas of the country. If you’re travelling and you get sick, you can go see one of their network doctors, let’s say you live in Louisville, like I do and you’re up in Chicago, there’s a network doctor that you can go see but you you’re locked into their network, networks change every year, doctors go in and out of networks every year and as I mentioned earlier, you find out that all of a sudden your doctor isn’t accepting the plan. That’s what happens. So, you have a lot more limited coverage with Medicare Advantage plan. Dental vision hearing, everybody loves that it’s a big thing on television.

It’s there, it’s very limited. Most plans have a maximum of $1,000 that can be spent on dental, even less on hearing and vision. So there’s extensive coverage and the last thing that you hear a lot about with Medicare Advantage is we’re going to put money back into your Social Security account. Well, that’s called a Part B give back. Most of the companies I shouldn’t say most, a few of the companies have plans that will give you anywhere from $50 to the full $143 a month back into your social security. But when they give it they take it away. 

Mary: Right, of course

Marty: That they don’t give you something for nothing. My father used to say, if you’re dealing with a plan that he has to give back, there’s going to be more restrictions somewhere else in the plan. This is why it becomes critical to get a plan that’s custom tailored for you. That’s why it’s critical to deal with somebody who understands the Medicare arena and can take you through all the pros and cons of everything. 

Mary: Well, most definitely. 

Marty: Really flying up here right now. So 

Mary: Yes.

Marty: So just, so we understand. 

Mary: No, it’s that’s why it’s so challenging to know, to listen to like these TV ads and to really make an informed decision about what your care should be. I mean, I was carrying an insurance policy, and they no longer carry it. So they were giving me a new primary care physician and I said no I’m not going to someone new, like you were saying, you know, you build up that rapport with that physician, you don’t want to change.

Marty: Right

 So, what other things should Medicare recipients be looking out for in terms of like these drug insurance plans, I know that Medicare supplements can be very expensive they can go, I mean, isn’t there like up to F through N or something? 

Marty: Yeah, the plans are all lettered. Let’s talk about the 3 most popular plans real quick, there’s a change, which is a comprehensive plan that covers everything. Now, for people who were eligible for Medicare prior to January 1 2020. There’s also a Plan F, which also includes that the only difference between an F and  G is the F plan includes your annual Part B deductible, not a big deal. Okay. But G is the is the comprehensive plan, and is the next most comprehensive plan. The N covers everything that the G does but for a lower premium, you may have to do a co-pay, a $20, copay to a doctor a $50 copay to a hospital.

Under the G there’s no co-pays under the M there is, but oftentimes that premium can be $ 50- $60 a month less on the N plan that is on the G and the third plan that I recommend more often than not in the supplement world is what’s called a High Deductible G. Now only a few companies write a High Deductible G. But you have a very, very low premium. In most of the cases, I’m dealing with that premium is anywhere from depending on the company $39 to $55 a month, all the benefits of that comprehensive G plan, but you’re responsible for the first for 2022, it’s going to be first $2,490 that Medicare won’t cover. So for example, you go to the doctor, Medicare approves $100, they pay they’re at 80%. That’s $80. There’s $20 left over that normally the plan would be if you were on a G plan. Under the high deductible G you pay that $20 out of your pocket, it gets deducted from that $2,490 and you have $2,470 left for the year. It’s a good viable alternative for people who don’t go to doctors quite very often, who don’t have a lot of health care needs, but want to ensure their protection down the line should they get sick, because now all you know is your maximum exposure is going to be my premium plus $2,490. After that the plan covers everything.

In the Medicare Advantage world, your maximum out of pocket even though there’s no zero premium that could go anywhere from $6,700 up to $11,000.

So it’s a matter it starts to become a matter of health coverage method.

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