Senior Benefits, Inc.
Join your hosts Nick Keene and Zach Haire fireside as they discuss the things you need to know as you or your parents begin to live out your golden years. With over 50 combined years in the senior market across the country, Nick and Zach are experts in the senior market and are here to help you live a healthy, full life.
This show's focus is on providing information on Medicare and products that most people won’t take time to explain. They dive into the hard questions and explain things in an easy to understand way. They also have guests on that work in different areas of health and wellness that will be able to give insight and address ways for you to stay healthy.
Some of the highlights of the show include: A brief rundown of Medicare Part A, who is covered under the plan, and where their coverage might run out The differences between Medicare Part A and Medicare Part B, and which one has a premium IRMAA and how it can allow people to pay less or more for their premium depending on their income How Medicare Part B costs break down Which part of Medicare pays for the shingles shot What Nick and Zach think listeners should know about the Medicare Part D’s “doughnut hole” How Medicare Advantage plans can help fill Medicare gaps Why you can’t really have a Medicare Advantage plan and a supplement plan Why it’s never too early to start saving for retirement And more! Quotes“Part A is paid in typically via payroll contributions, 10 years or 40 quarters, and there is no premium. With Part B there is a standard premium and in the year 2021, that premium is $148.50 per month.” — Nick“Part B is elective. So, whereas Part A is automatic, there are plenty of individuals that are still working when they turn 65. They may have insurance through their retirement, through their union; that's considered credible coverage, so it's certainly elective.” — Nick“The important thing to remember folks is prescription drug plans all have to meet a minimum benefit that Medicare determines, okay? And what that means is they have to cover at least two drugs in every therapeutic class. However, some drug plans may cover different drugs in those therapeutic classes. So it's important that you reach out to a professional.” — Nick“A lot of times with an Advantage Plan, you're looking at paying less than the front end where you might possibly with copays and deductibles on the back end see a bill.” — Zach“I recently turned 60. So, a lot of what I'll talk to you about is really based on my own experiences. I'm going through this in real-time.” — Ty Wooldridge“My background was in actuarial science, and I can tell you that the time value of money is an important ally when you're retiring. If you just took $50 a week, and you invest in that, even at a really low rate, like 4% which, as an average rate for 40 years, which is fairly low, you have a quarter-million dollars by the time you're 40 years out.” — Ty WooldridgeTranscriptAnnouncer: Welcome to our fireside chat with Seniors Living Healthy, the podcast that helps prepare and educate you as you enter and live out your golden years. With over 10 years of experience, Nick and Zach are experts in the senior market and are here to help you live a healthy, full life. And now fireside with your hosts, Nick Keene, and Zach Haire.Zach: Hello, and welcome back to episode six of season one of Seniors Living Healthy. I'm joined here as always with Nick.Nick: Hello, folks.Zach: So, this episode, we're going to wrap up what we've covered the first five episodes this season, touch base over what we have talked about, do a little refresher, review course. And then we're going to look into what next season is going to bring, and that's where our guest, Ty Wooldridge, President of Aetna Senior Supplements, will come in. We interview him, kind of looking forward to financial security once you do retire. So, as we just jump in here, we're going to talk about the parts of Medicare and the different things out there that can fill in those gaps in Medicare. Nick's going to run through those for us. I'll ask him some questions, he'll just review them real quick to make sure everybody's up to speed if you're just now joining us, you’ll know we've touched on the last five episodes. So, Nick, as you know, we've been discussing the parts of Medicare this past season. Nick: Sure. Zach: So, real quick, let's start out with Part A of Medicare, give the listeners a run-through on that.Nick: Yeah, so I want to start out real quick with the Part A and Part B, Zach, about who qualifies, when they qualify, and when they get it. So, individuals that have worked 40 quarters or 10 years and paid into Medicare, [unintelligible 00:01:45] payroll taxes mainly, qualify for Medicare, including any dependents and or spouses of those individuals. And other individuals, whether it be through disability, in limited circumstances regardless of age, or end-stage renal disease, or ALS can qualify as well, Zach. So, back to Part A, your question. Part A is hospitalization. Anytime an individual is admitted to the hospital, they are covered under Part A and a couple things to remember under Part A is there is a period of care: that is 60 days, and that is covered with a $14058 deductible in the year 2021. So, beyond that, there are additional day costs, day 61 through 90 in the period of care $371, and then 91 through 150, they're responsible for approximately $742 per day. The other thing that we're seeing more in this market as it regards to Part A, Zach, is skilled facility care. I know you and I talk with clients about this quite frequently. But skilled facility care comes in a lot when people have to go to rehabilitation facilities, whether it's following a stroke or some sort of debilitative condition. And if they are in the hospital for three or more days, and released, and admitted to a skilled facility within 30 days, Medicare will pay day 1 through 20, and then they're responsible for day 21 through 100 at approximately $185 per day. And that pretty much rounds out Part A, Zach.Zach: Great. So, real quick on Part A, circling back there talking about the days in the hospital, the window of care, we know it's a 60-day window of care. Kind of, explain how that resets, how that works.Nick: So, a period of care ends when an individual goes 60 days without care in the hospital or surrounding arena. So, not to be confused with the first 60 days period of care that's covered under the Part A deductible, but also beyond that going 60 days without additional care.Zach: Great, perfect. So, rolling in there. Next part is our Part B of Medicare, which is a lot more in play than Part A does.Nick: Absolutely. So, Part A is paid in typically via payroll contributions, 10 years or 40 quarters, and there is no premium. With Part B there is a standard premium and in the year 2021, that premium is $148.50 per month. There is something called IRMAA, Zach, that can allow people to either pay less for their premium or more, depending on their income. Your Part B is elective. So, whereas Part A is automatic, there are plenty of individuals that are still working when they turn 65. They may have insurance through their retirement, through their union; that's considered credible coverage, so it's certainly elective. Reach out to us, reach out to someone to answer your questions about what may work or what may not work in that regard. But if someone does elect to take Part B, they can expect to pay a premium typically. And Medicare Part B has an 80/20 coinsurance: Medicare pays 80% of all outpatient claims, and the insured is responsible for the remaining 20% after a $203 outpatient deductible.Zach: So, a little trivia question for you, Nick. We get asked this all the time: Part A or Part B; which one pays for the shingles shot?Nick: Shingles. That's a good question. Shingles is covered under the Part D. Your flu shot is the common shot covered under Part B.Zach: All right. There you go. So, leading into that, like Nick just said, your Part D of Medicare. That's probably our number one complaint—Nick: [laugh]. Yeah. Absolutely.Zach: —that we get because our hands are pretty tied on that. Kind of want to touch base on those there, Nick? Nick: Yeah, so one of the biggest challenges that we run into Part D, Zach, is they're regulated. You can only make changes, typically October 15th through December 7th outside of your open enrollment or new to Medicare phase. And with effective dates taking effect 1/1. And outside of limited instances, people are locked into those plans, January 1st through December 31st. And people's medications have a way of changing. A lot of times we get individuals that we run a drug plan, it seems like a perfect fit. Things arise, health conditions arise, new medications come into the picture, and we get phone calls, “Oh, this medication costs $100 a month,” or whatever that is, the important thing to remember folks is prescription drug plans all have to meet a minimum benefit that Medicare determines, okay? And what that means is they have to cover at least two drugs in every therapeutic class. However, some drug plans may cover different drugs in those therapeutic classes. So it's important that you reach out to a professional, reach out to us, let us look into the options. Let us get a list of your scripts, your dosages, the frequencies you're taking them, let us make sure that we get you with a preferred pharmacy that's going to offer you the lowest cost for your drugs. All of those things are important when it comes to picking a drug plan. And keep in mind, Zach, just to circle back, with Part D and Part B, if a Medicare-eligible enrollee doesn't have credible outpatient or Part B coverage or Part D drug coverage, they can be penalized by Medicare.Zach: Yeah, they'll get their part, cut one way or the other, that's for sure. So, one more thing I want to touch on Part D of Medicare, we get questions all the time, the dreaded doughnut hole. Do you want to touch on that real quick?Nick: Just to build up to the doughnut hole real quick, Zach. There's four phases in a drug plan: the deductible, the initial phase, the doughnut hole, and the catastrophic phase. And one of the things to keep in mind is, it's dollar amount thresholds that move from one portion or phase of the drug plan into another. So, when an individual and the insurance company reach a combined out of pocket total of approximately $4100, they enter into the doughnut hole, in 2021. And once they enter into that doughnut hole, then it's an approximate combined total of $10,000 that has to be spent between the insured, the insurance company, and the drug manufacturer before they get out of that gap. So it's an approximate $6,000 gap that individuals can be responsible for a high portion of cost of certain drugs. So, we get a lot of complaints: “I had flat copays on my drugs. All of a sudden, I hit the doughnut hole, and now I'm paying 40-some percent,” or whatever it may be of that prescription. One thing to know, folks, is all drug plans are built with a doughnut hole. The only difference being is some plans offer additional coverage within the doughnut hole. But of course, that's at an additional cost.Zach: Definitely. So, as we've seen there, there are some gaps in especially your A and B of Medicare. We do work mainly here a lot of times in ways to fill in those gaps. And we've touched on those as well. And the two different ones. The first one is the Medicare Advantage Plan. And, Nick, discuss how that doesn't really fill in the gaps. What is an Advantage Plan on the surface before we dig into it?Nick: Yeah, and one of the things to keep in mind about these products is as we go through the Medicare Supplements and the Medicare Advantages: there's pros and cons to both products, and one product doesn't fit everybody's needs. That's where a professional needs to ask you the right questions. How often are you using your healthcare? How often are you going to the doctor? Do you have any pre-existing conditions, et cetera? But one of the things that Medicare Advantage Plans do, Zach, and I think is what you're alluding to, is they actually replace an individual's Part A and Part B of Medicare. So, it can create some network limitations. Medicare is nationwide: California, North Carolina, Michigan to Florida, whereas those MAPDs—or Medicare Advantage Plans—have networks associated with them.Zach: Since it does replace the A and B, they have to be similar where you to go in the hospital. I know, like I said, plans vary a little bit. You're on a Medicare Advantage Plan; you go in the hospital. What kind of expenses should you be looking at to incur? Nick: Yeah, so on original Medicare, you have that $14058 deductible that covers your initial period of care. So, Medicare Advantage Plans do something similar—and keep in mind, they're all different, so I'm just going to talk in broad terms—but typically your Medicare Advantage Plans are going to have per-day cost when you go into the hospital, whether that's a day one through three, day one through five, day one through six, there's going to be something similar or equivalent to the Part A deductible of original Medicare.Zach: Great. So you're talking about the networks and everything there. There are a couple of different types of plans out there, I know when it comes to HMO and PPO; those are the two biggest ones we see. Kind of give a quick run-through, if you don't mind, the difference in the two of them.Nick: Sure. So HMOs, in our business, we know is the gatekeeper policy. Everybody that takes their state license test, regardless of where you take it, you get the gatekeeper question. What that is, is an HMO is a type of policy that is designed to be administered solely through the primary care physician. Any healthcare an individual gets, they have to go through the primary care. And to see a specialist or go out of network, they have to get a referral. That's the gatekeeper giving that pass, that referral. Whereas an HMO is a little different, Zach. And by the way, the HMOs are smaller, typically, in-network; they're for individuals, certainly, that don't travel much, as they don't have much out-of-network coverage short of emergency care. PPO—Preferred Provider Organization—policies don't require a referral. And what that means is an individual can get care in-network or out-of-network, albeit at a higher cost, so it gives them a little less restriction, and moving about, and traveling, and not having to be near their primary care physician.Zach: Gotcha there. There looking at Advantage Plans, just from what we know about them, a lot of times they are zero premium. There are ones out there that have premiums. But I think you'd agree, Nick, a lot of times with an Advantage Plan, you're looking at paying less than the front end where you might possibly with copays and deductibles on the back end see a bill.Nick: Oh, absolutely. I mean, there’s—look, there's no perfect way to go about this. You either pay on the back-end when you use it or you pay upfront, and kind of go from there, right?Zach: Yep, so next, moving in with that is the Medicare Supplement. And in the name itself, it supplements Medicare. So, looking at it there, Nick, give a rundown of Supplements, what someone should be looking for, in there in the Supplement market?Nick: Absolutely. So, I think you said it all up front, Zach. It supplements Medicare. What does that mean? Medicare remains the insured or the client’s primary, which gives them access to doctors, facilities nationwide. And the good thing to know about a Medicare Supplement, whereas a Medicare Advantage Plan replaces Medicare, a Medicare Supplement falls in behind Medicare. Medicare still pays primary, Medicare is accepted almost nationwide, anywhere we go. Rarely ever do we run into a doctor or facility that doesn't accept Medicare. And the good thing to know about the Medicare Supplements is regardless of what company or plan you go with, as long as the facility, the hospital takes Medicare, they'll accept any company's Medicare Supplement policy. So, with that, Zach, I mean, there's a number of different plans. I'm not going to go into all of the different ones, but it's one of those things where once again, we need to be asking the health utilization questions. How often are people going to the doctor? Do they have any pre-existing conditions? Are they looking for a plan that pays everything regardless of the cost, or are they more motivated by savings opportunities, maybe being willing to take on a small deductible or take on a small copay each time they go to the doctor? So there's multiple common plans, and not one is best for everybody. That's where our questions come in. That's where we come in.Zach: Yep. So I'm looking there, putting the two together. If I'm getting ready to go onto Medicare and looking at the two or say I’ve been on Medicare for a few years, made some changes, how does my health play into this? Nick: Yeah. So, with Medicare Advantage Plans, there are no health questions. Basically, if you reside or live in the plan service area, and you have Part A and B, you qualify for any Medicare Advantage Plan at any age. Medicare Supplements are a little different. Outside of select periods, being the open enrollment period and guaranteed issue periods where an individual would lose credible coverage through no fault of their own, all of your supplement companies—in most states; the standardized states at least—are going to have health questions. Now, some companies are going to be harder to qualify; for some companies, not so much. But the good thing about health questions, especially for healthy people is the more nos you can give me, the cheaper your price goes. So, health plays a big part in the Medicare Supplement market, and that's why it's so important, Zach, for individuals that are new to Medicare to think about this up front because if they have some of those chronic conditions that we see all the time in our market, it's a get out of jail free card, they qualify for anybody. So, if you're new to Medicare, about to be turning 65, or about to take on Part B of Medicare, you're in a select window that is your time to shine. Reach out, give us a call, talk with us, let us ask some questions, and let us make sure that we set you on the best track forward moving into Medicare eligibility.Zach: That's another big thing, too we haven't touched on yet are Supplement Plans. There's a lot of plans out there using Plan G, for example, plans themselves are standardized. Nick: Sure.Zach: So, real quick here at Senior Benefit, if you touch on what we do, if you're already on a Supplement with those plans being standardized, what we can do for you.Nick: Absolutely. And later on in this podcast, I'm looking so forward to speaking with Ty Wooldridge at Aetna Senior Supplements; this is what they do. But as a broker here, not only do we work with Aetna, not only do we work with all of these A-rated providers, when it comes to Supplements, they all offer the same products. They just have different qualifications, maybe different prices, some companies may offer a household discount, others may not. So, our job is to find the individual the plan that best fits their needs and then the lowest price. So, working with all of these major providers, not only do we have the opportunity to give folks impartial advice about what plan is best for them, then we also have the ability to give them that plan at the best price out there.Zach: Yep, definitely. Last one here on that note, we get asked this a lot: can you have a Supplement and an Advantage Plan?Nick: Technically no, Zach. When you have a Medicare Advantage Plan, you replace your Medicare. So you're on a Medicare Advantage Plan, not quote-unquote, “Parts A and B of Medicare.” That fundamentally runs against everything a Medicare Supplement is. To supplement Medicare, you have to be on Medicare. So, by definition, you can technically have a Medicare Supplement and Medicare Advantage, but the Supplement’s not going to pay anything. Because Medicare's not paying primarily, therefore the Supplement won't pay secondarily.Zach: Yep. Thanks, Nick, for kind of running through everything we've covered there the last five episodes. Hope it caught you guys up or maybe cleared some things up, answered more questions for you. So, now we look forward to jumping on a phone call here with Ty Wooldridge.Zach: All right guys, and welcome back. So, for our next segment here, is our interview section. So we're going to have Ty Wooldridge from Aetna Senior Supplement jump on the line here with this. He's actually the president of the Senior Supplement side of Aetna. Ty, how are you doing today?Ty: I'm doing well. And I certainly appreciate you guys having me on today. And absolutely glad to do it. Nick: Thanks, Ty, we appreciate you joining us.Zach: Glad to have you on. We know you've been working this market for a very, very long time, so as we look forward to our next season on the podcast, where we're going to be looking at people getting ready to retire and make sure they have that financial security once they get to that point in life. And we just wanted to run some questions by you, let you help some people out in that area. And I know you just joined that market here recently yourself. [laugh].Ty: Yeah, that's right. Yeah, I recently turned 60. So, a lot of what I'll talk to you about is really based on my own experiences. I'm going through this in real-time. Zach: Yeah, perfect, perfect. So, first up their Ty, if you don't mind, share with us the importance of financial planning moving into retirement?Ty: Well, sure. And honestly, even before you get to be my age, really, the importance of financial planning starts as early as possible. And you guys probably remember, my background was in actuarial science, and I can tell you that the time value of money is an important ally when you're retiring. If you just took $50 a week, and you invest in that, even at a really low rate, like 4% which, as an average rate for 40 years, which is fairly low, you have a quarter-million dollars by the time you're 40 years out. So, really the most important thing is you absolutely want to start; it is never too early to start. But as you near retirement, what you have to understand is, you move away from putting money away and taking care of that, you switch into an era where your money is now going to take care of you. It's going to switch direction. And as you near that retirement, it's important to ask yourself a lot of questions; get some help. You really have to plan this; you have to think about how much money do you need? How healthy are you? Because that can matter some of the decisions you have to make. What restrictions are there on how or when you can access the money that you've set aside? Are you planning to continue to work? How long do you think you will live? How much other income do you plan to have? Those are things you absolutely have to think about. But even more important than that, when you get into this area, kind of, where I’m in here, you start thinking about all this money changing directions and taking care of you, got to think about the impact of taxation. And that's where you really need to do some planning. How you move money from wherever you’ve got it stashed to the distribution phase of your life can matter a great deal on how much you're going to lose in taxes. It can depend on the instrument that you used to have saved the money, or how much you took out, or when you take it out, whether or not you're married, your tax bracket. All those things come in, and it really is best to even get a little help with that. And I know you guys are big into that area and you certainly have my thanks. I mean, you do some great work helping people with this because it is very, very difficult.Zach: That's probably the biggest thing we get here is like you stated, people being worried they're going to outlive whatever they put up—Ty: Absolutely.Nick: —in today's world, today’s time, people living a lot longer than they used to. And we answer that question, or talk to that question about people, almost on a daily basis here.Zach: Wrapping up your answer to that question, some of the things that we get asked most frequently are individuals with savings accounts, 401k, they're about to start taking on Social Security. When should they take Social Security, et cetera? Tell us how those things can impact someone looking at retirement.Ty: I would say the biggest thing you have to think about is whether or not you want to be your own investment manager or you want somebody to help you with it. If you decide that you're going to be your own investment manager, regardless where the money is, you're going to need to be prepared to invest your money and assume the full risk of that return. You can go out on your own, you can purchase an annuity that's going to provide some guaranteed returns or you can invest it in the stock market or other things, but the key is, you're going to be deciding for yourself what you want to do, and you're taking on the risk that it's going to last long enough. Now, if you want to seek the help of a professional, you absolutely want to choose wisely. And I don't know if you guys are familiar with the show American Greed, but nobody wants to be on that show. Nick: Absolutely. Ty: And you have to remember, if it sounds too good to be true, it probably is. It took you a long time in life to save whatever you manage to save; you want to make sure that you're very careful and thoughtful in thinking about, well, how do I want it to pay out. And you do have to think about not just yourself, but if you're married, you have to think about that. There is—unfortunately, it's pretty likely that one of you will proceed the other one in death, and you want to be thinking about taking care of that other person. There may be a lot of other things to think about. But absolutely, when thinking about this, whether you decide you want to do it yourself, or you want to get the help of a professional like you guys, you absolutely want to think that through because you can you can actually—there are a lot of instruments out there, as you guys know, that will pay you in installments and they'll take the risk on that you'll live too long. Now, they're not going to pay you perhaps as much as if you managed it yourself, but those are the things you have to think through.Zach: Perfect there, Ty. So, building off what Nick said there as well, social security is one of the options out there. What are some benefits to taking so security at 65, or delaying it until a little bit longer down the road? Ty: Well, the first thing you got to remember is your actual retirement date might not even be 65. Mine is actually 67 because of when I was born. But the decision of when you want to take your Social Security benefits can be a complicated one. I mean you're actually playing for how much you're going to get per month. I mean, if you retire before your full retirement age, then you're going to get less per month than you otherwise would get, and there's a discount. You can retire as early as 62, but that may mean you might end up receiving as little as 70% of the full benefit that you've earned, depending on your birth. Now, on the other hand, if you wait until after your full retirement age, you're going to get a little bit more. It adds generally something like 8% per year, I think, is about as much. But again, it's a fairly complicated formula, and it depends a great deal on the year you were born. But the thing is, you've got to think about well how long am I going to live and how much am I going to need to spend? There may be some very good reasons for taking it early. If your health isn't good, and you believe that perhaps you won't live to be 100, it may make more sense to take a smaller number now, then wait, or if you're not really particularly reliant on Social Security, and you've already retired by the age of, say, 62 or something, it may make sense for you to go ahead and accept it. But the other thing you got to remember is you're also playing with taxes. If you retire early, but you're still working, your benefits are likely to be reduced or offset. And social security benefits can also be taxed depending on the amount of income that you're earning. So, it may not help you very much to do this early. Of course, as I said, your health and your life expectancy: big factor in the decision. But another thing you got to remember, if you are married, and you're thinking about a surviving spouse, or if you have a disabled child or something along those lines, retiring early, that smaller benefit impacts them, too. And the calculations following your death, they will be impacted, they will be, in all likelihood, subjected to a smaller amount than otherwise had you not waited and retired on schedule. But here's the one thing that I would say to anyone: be sure to have the Social Security Administration office that you're dealing with compute your benefit every way possible before you make a decision like that. It can be fairly complicated. And in many cases, depending on your life and what's happening with you, there's more than one way to compute the benefit, and some of them may be decidedly larger than others. So don't be afraid to get some help with that. And if you don't really want to deal with people directly, you'll find that the ssa.gov website is actually pretty helpful in helping you make those decisions.Zach: Perfect. Thanks, Ty. That's a lot of help, I'm sure, to a lot of our listeners out there because that can be a big burden on their mind, coming up on retirement.Nick: Absolutely.Ty: Absolutely.Nick: We get that question with people becoming new to Medicare daily, I would say. Rolling into the next topic here, Ty. We know Aetna’s always up to some good things. Tell us the different ways that Aetna’s looking at working with this market to secure their financial future?Ty: Right. As you guys know, we have traditionally been in health insurance. That's been what we've done. We've worked with, you know, Medicare Supplement is the business that I run for Aetna, and I’ve been very successful there, but over the years, we've discovered that seniors have a lot of needs that sometimes insurance can fill. And over the years we've added things like cancer coverage, we've added life insurance protection, we've added dental insurance, a lot of things like that because they’re needs that seniors have. And in that line of thinking, you know, we continue; we always have something in the workshop, something in our research and development area that we're looking at. For example, later this year, we're going to be rolling out a new life insurance product that will have a substantial discount if you already have Med Sup with it. We think it’s going to be very exciting for folks. We're also going to roll out a new product, a new dental product that is more comprehensive than the one that we have in the market today. And we've been playing around with some other things that, maybe, people would be less accustomed to seeing come out of someplace like Aetna. And those are the kinds of things that we're tinkering inside. And we'll see if we ever really trot those out. But among them are things like companion insurance, which is really a form of pet insurance designed for seniors. And we've even talked a lot internally about the possibility of offering a multi-year guaranteed annuity for folks because making your money last is extremely important to seniors. More to come on that, but those are things that we're working on behind the scenes.Nick: Very cool. And one thing that I want to point out to the listeners out there, if you're a Med Sup client of ours, whether with Aena or another company, reach out to us in the near future. This is an opportunity not only to get some great rates with a great company on your Medicare Supplement but also an opportunity to get some great rates on a final expense policy as well.Ty: Absolutely, guys. And listen, hey, I really appreciate you guys having me on. This has been a lot of fun. I always enjoy talking to you guys. Nick: Very much.Zach: Hey, no problem. Thanks for joining us, Ty. Just in closing here, I know you touched on a few things. Anything else about Aetna here you want to let the listeners know anything about it?Ty: Well, honestly, I guess I'd want to say thanks. I've just celebrated my 10th year working with Aetna in this Medicare Supplement, and we've grown from an organization that had… I think we had 140,000 members. 140,000 policyholders back when I came on 10 years ago. Today, we're approaching one and a half million.Nick: That’s awesome.Ty: The growth has been tremendous. Certainly, you guys had an awful lot to do with that. I appreciate that. But I know your listeners, many of them are going to be policyholders, and we really appreciate the trust that you guys put in us. We work hard at this. It's a great business, we love it, we wouldn't want to be doing anything else. And certainly, we want to do all we can in the coming years to add other things that people need. And of course, our relationship with CVS is also very important to us. We'll be looking to try to leverage that in coming here as well. So, a lot of work to do. Certainly not ready to retire just yet.Nick: [laugh]. Just want to follow that up. We appreciate your time, and I want to let our listeners know we support Aetna, we think it's a great company. And now you know why. There's why straight from the top. Ty, we appreciate your time. You have a blessed day, sir.Zach: Thanks for joining us, Ty.Ty: You bet. You guys, too. Absolutely. Thanks, guys.Zach: No problem.Zach: Again, we want to thank Ty Wooldridge for taking time out of his busy schedule to join us and answer some tough questions about retirement and find that financial security, once you do retire; start looking into retirement. We hope you've enjoyed this episode as well as this past season. Our goal is to answer the questions we get on a daily basis and help you take on retirement like a pro, whenever that time comes for you. As always, thanks to my co-host Nick for joining me this season. Give us a call anytime: 844-437-4253, or email us at firstname.lastname@example.org or email@example.com. Or jump on our website seniorslivinghealthy.com, or our company website is getspi.com, either one. We'd love to hear from you guys. Call us, email us, fill out the information on our website. If you have any questions, concerns, that's what we're here for to help you guys out, answer your questions. We want to make sure that you have the best plan coverage out there for you to meet your needs as well as your budget. Like I said, we're always out here for you. And so here's to another prosperous and successful year, and good day and God bless.Announcer: Thank you for listening, and we hope you found this episode informative. If we answered your questions, odds are you aren’t the only one wanting to know. So, please share this episode with your friends and family. If you enjoyed this episode, please subscribe and rate our show on Apple Podcasts, or wherever you listen to podcasts to catch all of our episodes. If you want more information, or want to talk directly with Nick and Zach, you can call them at 1-844-437-4253. You can also find them on Facebook at facebook.com/seniorbenefitinc or on their website. seniors-livinghealthy.com. Thanks for listening, and have a great day.
30 min 28 sec
Some of the highlights of the show include: A brief primer on the history of Medicare Supplements Why Danny believes that Medicare Supplements are a great option for people How Medicare Supplements plans can’t be canceled based on a year of high claims The difference between when you can buy Medicare Advantage plans and when you can buy Medicare Supplements plans What happens if your doctor drops out of the Medicare Advantage plan you’re enrolled in The more popular Medicare Supplements plans that Zach and Nick see most commonly Changes to the Medicare Supplements program that just went into effect on Jan. 1, 2020 How Nick was able to help a couple save upwards of $2,400 on Medicare Supplements plans How Nick and Zach’s persistency can be a boon for clients And more! Quotes“President Johnson is the one that signed Medicare into law, and that was done in 1965. And soon after that, a multitude of companies brought out Medicare type Supplement Plans. they were going to cover what Medicare didn’t, but they could add bells and whistles and different things that way.” — Danny “That's what makes Medicare Supplements a great deal for people because it leaves them in control of what they want to do as far as their healthcare is concerned.” — Danny“Medicare Supplemental policies are secondary to Medicare, meaning Medicare is still their primary, meaning it's a nationwide program, they can go anywhere that accepts Medicare. And they're also standardized. So, the coverage from one company to another is identical from plan to plan.” — Nick “You can only buy Advantage plans at certain times of the year with the annual enrollment period, whereas you can buy a Supplement any time of the year.” — Zach“If you're in a Medicare Advantage Plan and your doctor drops out of it, there's nothing you can do until the open enrollment period.” — Danny “Medicare has evolved, coverages have been added, things have changed, and the same is true with the Part D. It's been evolving where it gets better and better as time goes on.” — Danny“Since the plans are standardized, we had the capability to find the same benefit package, the same coverage with another provider saving them a ton of money.” — NickLinks Seniors Living Healthy: seniors-livinghealthy.com Facebook: facebook.com/seniorbenefitinc Contact Nick and Zach: firstname.lastname@example.org 1-844-437-4253 TranscriptAnnouncer: Welcome to our fireside chat with Seniors Living Healthy, the podcast that helps prepare and educate you as you enter and live out your golden years. With over 10 years of experience, Nick and Zach are experts in the senior market and are here to help you live a healthy, full life. And now fireside with your hosts, Nick Keene, and Zach Haire.Zach: Welcome back to episode five of season one of Seniors Living Healthy. I'm your host, Zach, and with me as always, is Nick.Nick: Hello, folks.Zach: Also, we're pleased to be joined this week by Danny Haire, owner of Financial Services, Inc.Danny: Hi. How are y'all today?Nick: Doing well, sir. Thanks for joining.Zach: Thanks for jumping on here with us, Danny. So, he has been in the business for over 40 years, and can even remember back when Medicare Supplement Plans first came out. Danny, real quick, do you kind of want to just give us a quick historical rundown of Medicare Supplements, where they came from, who brought them out, that type of thing.Danny: Well, of course, President Johnson is the one that signed Medicare into law, and that was done in 1965. And soon after that, a multitude of companies brought out Medicare type Supplement Plans. The difference from those plans compared to today is there were no government standardized plans. Companies pretty much got to put together whatever they wanted to do. I mean, of course, they were going to cover what Medicare didn’t, but they could add bells and whistles and different things that way. And then as time went on, of course, the government standardized these plans. So, that was pretty much, I think, in the ’80s, when that happened, that these plans become standardized and everybody was selling the same thing, and there could not be any deviation from those.Zach: Gotcha. So, as we did discuss last episode, Medicare's got those gaps in it, and so there are plans out there to fill those gaps. As we talked about last episode, those Medicare Advantage Plans. So, this episode we're going to look at Medicare Supplements, and also, kind of similar to our last episode, instead of doing a product review, being this whole episode on a product, we're just going to kind of lump our interview portion in with our product review, just because it's going to flow so well together.Nick: So, Danny, quick question for you tell us why Medicare Supplement Plans benefit our clients?Danny: Zachary said earlier I've been in the business for well over 40 years. So, having seen changes and seeing what these plans can do for people in filling in the gaps, I just think it gives—anything that gives you control of your healthcare, in my thinking, is the best for you. You can go to any doctor, any time, any place. You're not in networks, you're not having to get pre-approvals or referrals. So, to me, that's what makes Medicare Supplements a great deal for people because it leaves them in control of what they want to do as far as their healthcare is concerned.Nick: Sure. Couldn't agree more. A couple things to point out also, Zach, that come to mind is Medicare Supplemental policies are secondary to Medicare, meaning Medicare is still their primary, meaning it's a nationwide program, they can go anywhere that accepts Medicare. And as you mentioned earlier, Danny, they're also standardized. So, the coverage from one company to another is identical from plan to plan. And more importantly, we get asked quite frequently, can these plans be canceled based on a year of high claims, or claims level? And the answer is simply no. The only way a person's Medicare Supplement Plan can be canceled is due to non-payment; it's what's called guaranteed renewability. Zach?Zach: Kind of going back, touching on a few of those points, you know, going through Medicare Supplements, as we talked about in the last episode—Advantage plans as well—you can only buy those certain times of the year with the annual enrollment period, whereas a Supplement, you can buy those any time of the year. As long as you can enter the health questions and qualify there. So, kind of on that note there, Danny, what are some pros to that capability to be able to purchase a MedSup and not—as you said, gives you the freedom. If you want to go a little more into that?Danny: Well, the freedom, to me, is the most important thing. Being of Medicare age myself, and having the flexibility if I want to change a plan, go from one plan to another, or go from one company to another, again, that's just part of the freedom and having that control that I've talked about, whereas, as you said, with the Medicare Advantage, there's certain times of year, there's certain special enrollments, maybe, that could happen. But if you're in a Medicare Advantage Plan and your doctor drops out of it, there's nothing you can do until the open enrollment period. As long as a doctor accepts Medicare, he's not going to drop out of Medicare, he's going—and so your Medicare Supplement will always cover it because, as Nick said earlier, it's a supplement to Medicare. Medicare covers the charge, and the doctor is participating in Medicare, then your plan’s going to pay.Zach: Definitely. Also too, as we've talked about in episode three and four—episode three being on prescription plans and four being on the MAPDs that include some prescription coverage—Supplements, what are they going to do for you, drug plan-wise, you know, coverage-wise, how would that work for somebody out there looking for prescription coverage along with their Supplement?Danny: Well, of course, President Bush was one that signed in the bill that included the Part D of Medicare prescription drug plans. Up until that time, the majority of people did not have drug coverage if they were on Medicare. There was, once upon a time, what was called a Plan J Medicare Supplement that did provide some prescription drug coverage in that plan. But the Part D is what really does the prescription drug coverage. It's like everything else; Medicare has evolved, coverages have been added, things have changed, and the same is true with the Part D. It's been evolving where it gets better and better as time goes on.Zach: Gotcha. And so, as we've talked about, as well, kind of going back a little bit to the plans being standardized, and as you just mentioned, a plan there, you know, there are several different plans out there in the market. There are some that are, of course, more popular than others. So, if we kind of want to run through those a little bit—maybe just hit on the more popular plans; we don't want to be here all day—going through plans.Nick: Yeah, Zach, that's a great question. So, there's a number of Supplement Plans currently on the market. But predominantly, we run into the same few over and over again, right? So, we have Plan F, Plan G, and Plan N. One thing to mention, Zach, recent legislation just passed, the MACRA legislation, limiting individual’s availability to buy a plan that covered the Part B deductible of Medicare. So, there's been a lot of news lately coming out about Plan C and Plan F, and there's a little bit of confusion around it, I think would be worth mentioning real quick. So, individuals that are newly eligible to Medicare, January 1st, 2020, or after, no longer have the ability to buy those two plans. However, individuals that were Medicare eligible prior to January 1st, 2020, can keep their current plan and purchase another Plan F or C for the rest of their life. So, that's worth noting. The other two plans mentioned, G and N are very similar to Plan F. Plan G has a deductible that an individual has to meet. And that, in the year 2020, is 198 bucks. And Plan N is the copay plan, right? So, Plan N is going to be responsible for the same deductible, going to be responsible for excess charges, and have a $20 copay—up to $20 at their doctor's visits and $50 at the emergency room, if they're not admitted. Check out our website or reach out to us to get more details on the other plans, but those are the most popular.Zach: Gotcha, gotcha. Like I said, Nick, kind of touching on some, you know, the plans a little bit there, some plans going and coming. Danny, kind of want to throw one out to you. Nick may touch on it here a little bit, but a new plan that came out in 2020, the high deductible Plan G. What do you think that could do to the market? What kind of options do you think that'll bring to—as we talked about earlier, a benefit to our clients.Danny: Until MACRA came along, people had access to the Plan F, where everyone had access to the Plan F and the high deductible Plan F. When that changed, of course, we came out with a high deductible G Plan. Basically, what the government's trying to do is they wanted to do away with plans that would pay 100 percent of everything that Medicare didn't pay. They wanted the insured to be responsible for the Part B deductible. And that's basically—with the Plan G it doesn't cover the Part B deductible, so technically that doesn't go toward the deductible of it. But if someone's healthy, especially if they're coming out of a major medical plan. A lot of these group major medicals, or even individual major medical, they're having $2500, $5000 deductibles, so they're used to paying money out of pocket. And the G Plan, the high deductible G, it has a deductible that any charge that Medicare doesn't cover that the plan would cover, it goes toward that deductible. But the good thing is Medicare is still paying what they pay. So, if you go in the hospital, basically all you're going to have is the Part A deductible that's going towards your high deductible G plan, and then the 20 percent of the doctor would go toward that deductible also, but after the Part B deductible, 80 percent would be covered by Medicare. So, again, if a person is healthy—and that's why they really need to be talking to you guys, and calling in—these people do—because it's really important to know what fits your health. If you're a healthy person, there's a lot of ways that you can save money by getting the right plan.Nick: And just to point out on top of that, Danny, there is certainly cost-effective measure for someone that's healthy, the amount of money that someone can save on a high deductible F or high deductible G, in most cases can cover half of that deductible, at least, in any given year versus a Plan G, or Plan F. So, reach out to us to explore some more options as it relates to that.Zach: So, Danny, thanks for jumping on here with us, again, and going through answering some questions kind of breaking down Medicare Supplements.So, next, as you guys know, we're going to do some Medicare confessions here. And Nick and I deal with Supplements on a daily basis. We talked to hundreds of people within a month, helping them, whether it be new to Medicare, getting on something for the first time, switching Supplement to Supplement, saving money, or an annual enrollment period coming off an Advantage Plan on to a Supplement. So, we could be here all day going through stories and everything, telling those. So, we decided, kind of going through it, Nick’s just going to pick out two or three that really stand out to him of a couple of different scenarios, how us helping somebody really, really benefited them.Nick: Yeah, Zach. So, as you said, we could be here all day giving specific examples of ways we helped individuals, whether that's taking advantage of open enrollment periods to get people coverage that they might otherwise not qualify for, whether that's switching plan to plan, saving money, or what have you. So, just a couple scenarios that come to my mind real quick. A couple years back, one of our agents got ahold of a couple from Sevierville, Tennessee, that were getting older in age. Had been on Supplement Plans a little over 20 years, and their rates had climbed to a point that we were actually able to get them the exact same coverage that they had had for a number of years, saving them a little over $2400 per year. So, since the plans are standardized, we had the capability to find the same benefit package, the same coverage with another provider saving them a ton of money. So, that's one way we can help folks.Another one is taking advantage of specific enrollment periods to get individuals covered. So, as we know, people have an open enrollment period when they are new to Medicare or turning 65 that allows them to purchase any Medicare Supplement Plan without health questions, without underwriting. We had an individual locally here to the office that had worked in the mines his whole life, and we got a hold of him, luckily, during his open enrollment period. He has black lung and a lot of complications that come with that as it relates to oxygen and some other things. We were able to get him a G Plan for just over 100 bucks a month, guaranteeing him that he's going to be insured for the rest of his future, getting him good and covered, and making sure that his health costs weren't a problem for him.And then the third one that comes to mind is persistency on our end, trying to help our clients. A couple years back, I came across one of probably my oldest clients, Zach, and had her on the books for almost three years and consistently tried to get her husband to purchase coverage from us, year after year, call after call, check-in after check-in, we finally got this individual covered. And less than four months after that happened, he had a massive stroke, was in the hospital in continuous skilled care for 100 days straight. We can go on about the costs that we save them, but ultimately, we saved them a ton of money in bills that didn't come in the mail. So, persistency on our end is a benefit that we offer to our customers as well. Those are just some scenarios that come to my mind in ways that we can help individuals on a day in and day out basis.Zach: Definitely. Like I said, there's a lot of different scenarios out there. We can help people, whether it being saving money, getting on a Supplement just to start, especially if you're getting ready to go on to Medicare, or take your Part B, or turning 65.So, we want to thank everyone for listening. Again, big thank you to Danny from Financial Services for jumping here with us and going through everything. And we hope we answered a lot of the questions about Supplements that you guys may have out there to help you fill in your gaps to Medicare. Remember it is in the name itself: it is secondary to Medicare, it's going to supplement that coverage there with Medicare. Again, all plans are standardized. So, Plan G, Plan N, Plan F no matter the company, they're all going to be the same across the board. Again, guaranteed renewable: as long as you pay those premiums, they can't drop you due to health. Purchase them year-round as well, so you don't have to wait for the Annual Enrollment Period in October. If you want to switch in May, June, July, something like that, you want to—look into saving some money, give us a shout, we'd love to help. Again 12-month rate lock as well, another big thing: they're not going to change the rates on you every month, once you start out, you know, where you go, going to be locked in there.So, again, guys, as we're recording this, we are getting close to Annual Enrollment Period, so definitely reach out to us. We'd love to help you, especially during that time of the year. Again, if any questions, you can always email us email@example.com, or call us, 844-437-4282. Always a good time to check in on your Medicare Supplement. We're more than happy to, at any time, run those rates, check them for you. There's never a bad time not to check them. So, thanks for joining us, guys, and until next episode, God bless and have a good day.Nick: Take care.Announcer: Thank you for listening, and we hope you found this episode informative. If we answered your questions, odds are you aren't the only one wanting to know. So, please share this episode with your friends and family. If you enjoyed this episode, please subscribe and rate our show on Apple Podcasts, or wherever you listen to podcasts to catch all of our episodes. If you want more information, or want to talk directly with Nick and Zach, you can call them at 1-844-437-4253. You can also find them on Facebook at facebook.com/seniorbenefitinc or on their website. seniors-livinghealthy.com. Thanks for listening, and have a great day.
16 min 35 sec
Some of the highlights of the show include: A brief refresher on Medicare Part A and Medicare Part B and the associated gaps in coverage The various types of Medicare Advantage plans, including HMOs, PPOs, and SNPs, and the differences between each of them Why it’s important to consider in-network coverage when shopping for Medicare Advantage plans The coverage benefits of Medicare Advantage Prescription Drug plans (MAPDs) Three big things that Medicare doesn’t cover What Medicare Advantage covers that Medicare plans do not Why Medicare Advantage may be more convenient than other Medicare coverage options When the Annual Enrollment Period is Factors to consider when shopping for an MAPD Why you should review your options every Annual Enrollment Period no matter what And more! Quotes“There are two options, really, when it comes out there to filling in gaps in your Medicare: Medicare Supplements andMedicare Advantage Plans.” — Zach“The HMO plans are primary care physician-based. Their networks are typically county-based or sometimes multi-county based, but they're for individuals that don't do a lot of traveling. They do have set copays on a lot of services, and they typically are relatively inexpensive.” — Nick“And then the PPOs: there is no requirement for a referral on a PPO. They typically are going to have larger networks, regional, or in some cases, national networks.” — Nick“The only thing that a Medicare Advantage Plan has to do is offer benefits equivalent to original Parts A and B of Medicare.” — Nick“It's important to note that Medicare Advantage Plans wrap up and replace Part A and B, but also incorporate Part D of Medicare in the same type of plan. So, unlike Medicare, and a supplement and a stand-alone drug plan, it's all in one card.” — Nick“Medicare Advantage Plans give you additional benefits that original Medicare does not cover. It basically Medicare Advantage Plan will pick up, like, deductibles, and coinsurance, things of that nature traditional Medicare does not cover.” — Tausha“Medicare Advantage over traditional Medicare has a stopgap in place that caps the amount of spending that you would do each year, which is called a max out of pocket.” — TaushaLinks Aetna: https://www.aetna.com/ Seniors Living Healthy: seniors-livinghealthy.com Facebook: facebook.com/seniorbenefitinc Contact Zach: firstname.lastname@example.org 1-844-437-4253 TranscriptAnnouncer: Welcome to our fireside chat with Seniors Living Healthy, the podcast that helps prepare and educate you as you enter and live out your golden years. With over 10 years of experience, Nick and Zach are experts in the senior market and are here to help you live a healthy, full life. And now fireside with your hosts, Nick Keene, and Zach Haire.Zach: Hello, and welcome back to another episode of Seniors Living Healthy. As always, I'm your host, Zach, and beside me is Nick.Nick: Hello, folks.Zach: You guys, this episode we're going to look into the different options to fill in those gaps that Medicare covers where we've talked about in the previous episodes, with Part A being your hospitalization, and Part B being your outpatient. There are two different options out there. One of them is Medicare Supplements, which we're going to touch on next episode, where this episode we're going to focus on Medicare Advantage. You may see him also called MAPD or Part C of Medicare. Especially with Annual Enrollment Period coming up, you're going to see a lot of TV advertisements, radio advertisements, billboards, things in your mail, all of that stuff, in regards to that.So, guys, as always, usually do a product review in our episodes, but since this whole episode is on a product, we're just going to jump right into it and just cover the whole product as a whole. And then, as always, we'll go into our interview, our confession section, and then wrap up the episode. So, now that we've talked about A and B has all these gaps, this episode—and we're going to spill over into next episode—we're going to talk about what covers those gaps that Medicare doesn’t. Some different options, everything out there for you. So, Nick, give me a quick rundown just to refresh everybody, what some of those gaps are?Nick: Sure, absolutely, Zach. So, the main two parts of Medicare Part A and Part B. As you alluded to, Part A is the hospitalization, Part B is the outpatient. So, some of the major gaps under Part A of Medicare are, Medicare Part A has a $1408 deductible per 60-day benefit period. And then also beyond that, for individuals that required skilled facility care beyond hospital stays, Medicare covers all but $176 day 21 through 100, with Medicare paying 100 percent, day 1 through 20 provided that an individual is in the hospital three days or more and admitted to that facility within 30 days. Then as far as Part B, Zach, as you know, Part B of Medicare has an 80/20 coinsurance. The clients are responsible for the remaining 20 percent that Medicare does not pay, as well as a annual deductible of $198 per year.Zach: Great, Nick. So, now we're caught up with the different gaps and everything out there. There are two options, really, when it comes out there to filling in gaps in your Medicare. One of them is Medicare Supplements; we're going to spend next episode talking about this one. So, this episode, we're going to talk about Medicare Advantage Plans. You may see that also referred to as Part C, or MAPD. That's a couple of different lingo we use in our industry. You'll see it, especially with Annual Enrollment Period coming up. So, you're going to see a lot of advertisements, billboards, radio ads, things like that for those products. And so, Medicare Advantage Plan, lack of better terms, it replaces A and B of Medicare.Nick: Absolutely. Yep.Zach: So, Nick, looking out there, there are several different types of MAPDs, you want to run through those real quick, maybe touch on the two main ones that are out there, and we'll go from there.Nick: Sure, absolutely. So, there's a number of different types of Medicare Advantage Plans that are offered on the market, Zach, but the few that are the most common are going to be the HMO, which stands for Health Maintenance Organization, the PPO, which is a Preferred Provider Organization, and then SNP plans: Special Needs Plans. Those plans are specified for specific portions of the population, whether that be dual-eligible Medicare beneficiaries, institutionalized Medicare beneficiaries or Medicare beneficiaries with chronic conditions. But back to the main two, the HMO plans are primary care physician based. What that means, Zach, is the beneficiary's care is all handled directly through their primary care physician, and any doctors or specialists within that network or outside, are only available to the client with a referral from that primary care physician. And their networks are typically county-based or sometimes multi-county based, but they're for individuals that don't do a lot of traveling. They do have set copays on a lot of services, and they typically are relatively inexpensive. And then the PPOs: there is no requirement for a referral on a PPO. They typically are going to have larger networks, regional, or in some cases, national networks. So, those are some options that individuals that may travel may be more appealing. And typically, they're also pretty relatively inexpensive as well.Zach: Great, Nick, so like I said, the plans themselves are fairly inexpensive, meaning a lot of them don't have premiums, or they have very small premiums. So, they do, kind of, replace Medicare a little bit. What are some of the gaps still? Are there expenses out, that you are still responsible for on an HMO or a PPO plan?Nick: Right. So, traditionally—and unlike Medicare Supplement plans that we've talked about on our podcast, or we will be talking about shortly—these types of plans, Zach, aren't standardized. So, the only thing that a Medicare Advantage Plan has to do is offer benefits equivalent to original Parts A and B of Medicare. So, in most plans, you are going to have, day one through five, day one through eight, you're going to have per day costs while you're in the hospital, individuals are going to have copays in a lot of instances, whether it's at the primary care, or the specialist doctor visits, copays at the emergency room, copays in some instances on lab work, CAT scans, MRIs, things of that nature. And keep in mind, folks, since these plans are network-based, in some plans more than others—HMOs for instance—if you go outside of the network, short of emergency care, and other limited instances, these plans don't cover. So, it's very important if you're on one of these types of plans, or are considering taking one of these types of plans, that you consider that when you are looking to purchase one.Zach: Great, great. So, what are some added benefits that these Advantage plans have? We talked last episode about prescription plans, and you do have MAPDs out there that—Medicare Advantage Prescription Drug Plan, as in the name itself, it does include your prescription coverage. So, one—a two-part question there touched on, the prescription component of an MAPD as well as any added benefits, whether gym memberships, things such as that, that a member client could get when enrolling in one of these plans.Nick: Sure. So, the added benefits are something that we get asked about this constantly. The first three that come to my mind, Zach, as most people know or may not know, Medicare does not cover dental, vision, or hearing in most limited instances. So, for instance, dental insurance: Medicare covers nothing dental, most of these Medicare Advantage providers are giving individuals either a dental allowance in a given year or in some instances are actually offering them dental benefits through these plans. Vision: another thing, eye exams, lenses, frames, things of that nature, Medicare doesn't cover. So, a lot of these providers are giving additional benefits in that regard on an annual basis, as I said, whether it's their reimbursement or traditional insurance. And then to touch on your other point, Zach, I think it's important to note that Medicare Advantage Plans wrap up and replace Part A and B, but also incorporate Part D of Medicare in the same type of plan. So, unlike Medicare, and a supplement and a stand-alone drug plan, it's all in one card. It's very simple for the senior market. They can take their card, whether they go to the pharmacy, the doctor, or the hospital, and know that that one card will be their coverage across the board. That's a huge benefit, sometimes.Zach: Oh, yeah. Yeah. Only keeping up with one card, especially in our market, that makes their life a lot easier.Nick: Absolutely.Zach: So, closing up this section here, we've hit on it here and there, we've talked about Annual Enrollment Period, things like that. When enrolling these plans, they are, as we've said, government ran, so they do have a little more restrictions, when you can enroll with those, sign up for those plans. Nick, if you want to touch on that real quickly—with AEP, in this sense, you know, it is coming up quickly—when can somebody get into one of these plans?Nick: So, there's three most common scenarios that an individual can purchase a Medicare Advantage Plan, or switch to another plan, or leave their current plan. The most common scenario that most people are aware of is, of course, AEP, or the Annual Enrollment Period. And that runs October 15th through December 7th of each year, so we are fastly approaching that period. But in this time, individuals that are Medicare eligible can make all three types of plan changes: they can enroll into a new Medicare Advantage Plan from original Medicare, they can switch from a Medicare Advantage Plan to a different Medicare Advantage Plan, or if they ultimately decide to leave a Medicare Advantage Plan and go back to Medicare, they can do that as well. So, all three plan changes are allowed in Medicare in AEP, and all of those changes take effect January 1 of the next year.Zach: And of course, if you are new to Medicare, you can enroll. You have three months before and three months after, of course, when you turn 65 or take your Part B of Medicare. A lot of those occur the same time, a lot of people, but some people do delay their Part B, which gives them that enrollment period.Next up guys, rolling into our next session here with our interview portion, we're going to be with Tausha with Aetna. Going to be jumping on a call with us answering some questions about these Medicare Advantage Plans.All right, guys, and so, for our next session here, again, it’s going to be our interview portion. So, as you know, this episode we've been talking about the Medicare Advantage Plans, Part C, MAPDs, a couple different names out there for them. And again, we are glad to welcome Tausha Mitcham from Aetna, their national sales director, getting her to join us here on the call, ask her some questions about these plans. What all is out there for him?Nick: All right. Tausha, I want to thank you again for joining us and we know your time is money, so we'll jump right in. What are some advantages of an individual Medicare beneficiary choosing a Medicare Advantage Plan or MAPD over traditional Medicare?Tausha: Sure. So, Medicare Advantage Plans give you additional benefits that original Medicare does not cover. It basically Medicare Advantage Plan will pick up, like, deductibles, and coinsurance, things of that nature traditional Medicare does not cover.Nick: So, kind of, additional benefits would be the synopsis there. Okay.Tausha: Mm-hm. And anything above and beyond, so wherever you have your gaps. I guess, like I said, copayments, deductibles for hospitalization, office visits, prescriptions, things of that nature.Zach: So, we touched on a little bit earlier in this episode, but what are some of the most common types of MAPDs, Advantage Plans out there on the market?Tausha: Sure, absolutely. So, it would be HMO plans, PPO plans, and POS, which we call Point Of Service plans.Nick: And just to follow up on that question, real quick. You know well as we do that HMO and PPO are by far the most common types. Tell us the, maybe, just two or three major differences between those two plans?Tausha: Sure. So, HMO plans, the best way to look at it is everything's authorized and directed through a primary care physician, and it's generally going to be a plan that you would utilize the network and physicians within, say, the county that you live in. Some of our plans do go beyond counties, but generally, it's always going to be within their respective state, and county, again, as I stated. And then a PPO plan, again, most often you want to be authorized and directed through a physician, of course, but it gives you more flexibility. With PPOs you generally don't have to get any kind of authorization in advance, you have a little more flexibility as it relates to going in and out of some specialists and primary care doctors, again, without having to get any type of a pre-authorization. And then with our PPO plans, we do have national models. So, we have national networks, if you will. And depending upon, again, the state that you're in and the county that you're in, what plans are available to you.Nick: Sure, okay. Maybe give us some of the types of additional benefits that some Medicare Advantage Plans cover that Medicare does not?Tausha: Sure. So, some examples would be dental, vision, hearing, transportation, over-the-counter, meals after hospitalization, and then the case of that MAPD, which is Medicare Advantage which includes a prescription benefit, it gives you prescription drug coverage all in one package. And then Medicare Advantage over traditional Medicare has a stopgap in place that caps the amount of spending that you would do each year, which is called a max out of pocket.Zach: Thank you for those little highlights there. So, we're out there, a potential client looking, getting ready to choose an MAPD, what are some factors they should consider?Tausha: Sure. So, what you want to do is consider whether you want a broad network; a specific provider; what your prescriptions that you need to be covered; your hospital system, you want to ensure that it's in-network—again, we always want to drive the network; and if you travel, you want to make sure that it's a portable plan, especially for emergency services. So, we just talked about portability would be those national type of plans that have a national [00:14:12 unintelligible] network so that you've got access to physicians outside of where you reside, especially if you're traveling.Nick: Very good. Thank you for that, Tausha. So, as we wrap up here, give us some information. Tell us about any exciting changes coming to Aetna CVS MAPD portfolio 2021.Tausha: Sure. Thanks so much. So, we are extremely excited about this, and it’s just great for us, our new SmartRx low premium PDP plan. So, it's under $8 nationally; it will vary based upon the state, but none of the plans will be over $8. Also, we have our Health Hubs. What Aetna CVS plans to do is have 1500 of them nationwide by the end of 2021. And our Health Hubs are there really to help for additional care in between a member’s doctor's appointments. You'll find them, generally, in CVS stores, and in some cases, it will also be Target where there's a CVS within the Target facility. Also, which I think is kind of cool, CVS is now allowing PayPal for the patrons, and possibly in the future, they're going to look to roll out Venmo which is kind of exciting. And then there's 115 expansion counties for Aetna, with 1 new state, 288 DSNP expansion counties with 9 new states, which is really big for us, and we're really trying to expand more of the DSNP opportunities. We have new HMO product offerings. And then there's a new veteran plan nationally as well and it's called the Eagle Plan. And just to know, 88 percent of Aetna members are in four-plus star plans. And then just a few other things just to know about CVS Aetna, with the integration of the company, you know, that we've done is we care about the whole member. So, we look at it as we're personalizing a bundle, and that's through our Medicare Advantage Plans which we talked about. Our HMO, PPOs, and some POS plans are SilverScript, which is our Part D PDP. DSNP specialty needs plans, Medicare Supplement, and then ancillary products, which could be hospital indemnity, cancer and heart attack, home health care, and more. And then lastly, one of the things that I pride myself on working for an organization that really embraced COVID-19 this year. We waived all of our COVID-related copayments, and then probably the biggest highlight is that as we had certain hotspots throughout the United States with COVID, CVS implemented testing sites to help with the testing process and to ensure that those tests were getting back fast enough to help citizens. And so that that would be the biggest highlight for us for ’21. We're super excited about them.Nick: Great. Thanks for that, Tausha. We are excited to see those product launches here in 2021, know those changes will be coming out soon. It's hard to believe AEP’s about to be here again. But we certainly appreciate your time this morning and jumping on and giving us some information for our listeners.Tausha: Great. Well, thanks for giving me the opportunity, I appreciate it.Zach: For our next part here, as always, our Medicare confession where Nick or I will talk about how we have helped somebody in this area, especially in the product—as in, we said this episode's product is your MAPD. Last Annual Enrollment Period, I'd had a client for several years, the wife had been on a Supplement, different options, things there, back and forth. And, as always, here at Senior Benefit, we want to find what works best for the client, meets their needs. We want to make sure the plan we put them in is the best for them. We don't just try to put a square peg in a round hole.So, she'd been a client for several years, hadn't really spoke to her husband very much. He had had a plan, was happy with it. And some things came up, wasn't very happy with his plan, and so he was ready to make a change. So, he had been on an MAPD Advantage Plan for several years. So, of course, during Annual Enrollment Period, we were able to review his options. Going through them there, we were able to find an MAPD that was going to really help his prescriptions more than anything. It was going to be a money saver on his prescriptions. He'd been in one for several years, never reviewed his options. He thought it just rolled over, same coverage, but as we know, unfortunately, things do change. Prices go up on prescriptions, companies may stop covering prescriptions, things like that. So that's why, you guys, no matter what you have out there, we do recommend every AEP at a minimum, reviewing your options. Like I said, we were able to switch this gentleman to a different MAPD, saved him a lot of money on his prescriptions as well as got him in a better network that suited where he lived with the doctors and everything he wanted to see there.All right guys, so in closing here, wrapping up this fourth episode on Medicare Advantage Plans, Nick and I would like to thank you for listening, tuning in. We hope this podcast answered many of the questions about your MAPDs. Remember, they are government ran, meaning you can only sign up during certain periods. And, like I said, AEP is right around the corner here, so it's a great time to look and see what you can do for this coming year. As well, a lot of these plans, they do have extra benefits. They may include some type of gym membership, gym discount, vision, hearing, dental discounts, things like that, as well as a lot of them do have zero premium, things like that with them. A lot of them do have their copays and deductibles, and also want to make sure while looking at a plan that you do find something in-network. You want to make sure that the network includes the doctors, specialists that you like to see. So, Nick, again thanks for jumping on and joining us here, and breaking down some Medicare Advantage Plans.Nick: Absolutely. Once again, folks, we thank you for tuning in, listening. Reach out to us, with AEP coming upon us, or any time of year for that matter. We'd love to work with you, answer any questions you have and go from there. Thanks again.Zach: Again, we want to thank Tausha with Aetna for jumping on the phone with us, and answering some questions about these Medicare Advantage Plans, and breaking it down, and tell us what Aetna's got new, coming in 2021. Again, if you ever have any questions about MAPDs or Medicare in general, you can give us a call, 844-437-4253, or email us, email@example.com. Guys, until next episode, good day and God Bless.Nick: Take care.Announcer: Thank you for listening, and we hope you found this episode informative. If we answered your questions, odds are you aren't the only one wanting to know. So, please share this episode with your friends and family. If you enjoyed this episode, please subscribe and rate our show on Apple Podcasts, or wherever you listen to podcasts to catch all of our episodes. If you want more information, or want to talk directly with Nick and Zach, you can call them at 1-844-437-4253. You can also find them on Facebook at facebook.com/seniorbenefitinc or on their website. seniors-livinghealthy.com. Thanks for listening, and have a great day.
21 min 22 sec
Some of the highlights of the show include: The two most common times Medicare beneficiaries are able to make changes to their prescription drug coverage The downfalls of not selecting drug coverage What Zach and Nick do to ensure their clients get the right prescription coverage The differences between the four different tiers of Medicare Part D prescriptions The four different stages of prescription drug plans What the maximum deductible is for 2020 How prescription drug plans operate a lot like car insurance What the Medicare doughnut hole is and why it’s a bear for so many people Why beneficiaries are most likely to complain about Medicare Part D vs. other types of Medicare What patients should do if they are prescribed a drug that isn’t on their plans Why it’s important for Medicare beneficiaries to choose a national drug chain as their pharmacy What Aetna has in store for 2021 What the process of enrolling in a prescription drug plan looks like And more! Quotes“These drug plans are regulated by the government and Medicare, and there's only certain election periods throughout the year that people can make changes or elect different coverage, so we get complaints about these plans non-stop throughout the year.” — Nick“Your Tier 1 drugs are typically going to be the most inexpensive in most cases. Lots of drug plans offer these drugs free of cost. Tier 2 are going to be preferred generics in a lot of cases or non-preferred generics that are a little more expensive but still relatively inexpensive; Tier 3 are going to be your brand name drugs, and Tier 4 are going to be your specialty drugs, like cancer drugs.” — Nick“You're going to pay the full cost of your prescriptions until you get through the deductible phase of your prescription drug plan.” — Nick“The reason the doughnut hole can be such a bear is for people that have higher, more expensive medications, their cost-sharing within this period goes up pretty substantially.” — Nick“We're going to be able to tell you when to expect to hit that doughnut hole, or if you're going to hit it at all, or when you hit that catastrophic phase moving forward there.” — Zach“We always try to make sure when we're running PDPs for our clients, you know, making sure—a lot of them like those little local drugstores; we try to get them to at least check the big chains out there in case they do travel.” — Zach“The key is always to choose a preferred pharmacy for lower drug costs. That's always the key.” — Tausha“CVS is now allowing patrons to use PayPal, which I think is pretty cool. And then possibly in the future, they might be able to use Venmo as well.” — Tausha“I just really wanted to just highlight the support that CVS Aetna has given around COVID-19. We waived all COVID related copayments, and I think what's probably stands out the most for me is that we opened multiple COVID-19 testing sites throughout the United States where we kind of had those hotspots. And CVS acted quickly and implemented those hotspots to help with testing.” — Tausha Links:Aetna: https://www.aetna.com/TranscriptAnnouncer: Welcome to our fireside chat with Seniors Living Healthy, the podcast that helps prepare and educate you as you enter and live out your golden years. With over 10 years of experience, Nick and Zach are experts in the senior market and are here to help you live a healthy, full life. And now fireside with your hosts, Nick Keene and Zach Haire.Zach: Hello, and welcome to episode three of our inaugural season of Seniors Living Healthy. I'm your host Zach, and here with me, as always, is Nick.Nick: Hey, folks.Zach: So, this month's episode, we're going to talk about Part D of Medicare, which is your prescription coverage. Nick, what is our number one complaint?Nick: Prescription drug plans, no doubt, Zach. For whatever reason, these drug plans are regulated by the government and Medicare, and there's only certain election periods throughout the year that people can make changes or elect different coverage, so we get complaints about these plans non-stop throughout the year.Zach: That's right. With our hands being so tied, it's really, really hard. We can't tell the future. So, we can't see what people are going to be doing, taking prescription-wise down the road; really, all we can do is what's working for them there in October when those annual enrollment period comes. So, I know we've touched there briefly on enrollment period but, Nick, what are the two most common times people can enroll in drug coverage?Nick: So, the two most common times people can make changes to their prescription drug coverage is going to be their initial enrollment period when they first become eligible for Medicare, which is a three-month window both before and after their eligibility, and then also the annual enrollment period, which is that period from October 15th, through December 7th each year, that they're allowed to make changes to that coverage.Zach: Great. Yep, definitely. Yeah, those are our two most common times. There are a couple of different scenarios out there. If you guys want to subscribe to our newsletter, that’s something we'll, kind of, touch in that, here in the next couple days we'll be getting out to you guys, to see the different options you may have out there enrollment-wise. So, Nick, when we were working with people looking at things, what should our clients keep in mind when we're working with them to select a drug plan? Because like I said, we can't tell the future?Nick: Sure, absolutely. So, Zach, what we try to do is find the best drug plan and drug coverage for our clients at the time. Not only that, but we want to make sure people newly eligible to Medicare know about the downfalls of not selecting drug coverage, whether that's being penalized for not having credible coverage through Medicare prescription drug coverage, group insurance, or retirement benefits, whether that is someone who is not taking prescriptions and just thinks they don't need it, we want to make sure they're not getting penalized. We also want to make sure that folks have the best drug coverage for them. So, it's our job to ask questions to make sure that we're informed, that we take care of our clients.Zach: Definitely, yeah. Trying to put the client there first is always want to make sure we get what works best for them. So, moving forward there, looking at the different parts of the prescription plan, the first thing we want to cover there are the tiers. Prescriptions are broken down into various tiers, that kind of breaks them down into cost, types of prescription, things like that. Nick, you want to touch on those real quick, what the different tiers are, and what that means.Nick: Yeah, absolutely. So, Zach, the way the tier system works, and by the way, Medicare is who is dictating what prescriptions are in what different types of tiers based on their cost. So, your Tier 1 drugs are typically going to be the most inexpensive in most cases. Lots of drug plans offer these drugs free of cost. Tier 2 are going to be preferred generics in a lot of cases or non-preferred generics that are a little more expensive but still relatively inexpensive; Tier 3 are going to be your brand name drugs, and Tier 4 are going to be your specialty drugs, like cancer drugs, things of that nature. So, it's important to keep in mind that these drugs are placed in their tiers based on the cost of the overall prescription.Zach: Definitely, yep. So, now we've broken down the various tiers that prescriptions are in. We hear a lot about different phases—periods—when we're going through a drug plan. Kind of touch on those, that way people have an idea of where they're at moving down the line.Nick: Absolutely. So, the way drug plans are created, folks, is Medicare mandates that there has to be a minimalistic benefit to all prescription drug plans that companies offer, and they also mandate that all of the plans have four different stages throughout the plan. And that's going to be the deductible phase, the initial phase, the coverage gap phase, and the catastrophic phase. So, realistically, there's four different plans and they all have different thresholds, involves moving down the cycle.Zach: Gotcha. Yep, definitely. So, look in there, that first one there being the initial deductible phase, kind of, briefly touch on it, then how they move into the next phase, which would be your initial coverage.Nick: Sure. So, some drug plans have a deductible and some don't, Zack. So, the maximum deductible that's allowed for the year 2020 is $435. So, no drug plans can have a deductible higher than that for the year 2020. However, some drug plans alternatively, have zero copay at a additional premium a lot of times. So, the way that works is very similar to car insurance. The analogy we use: if you get in a wreck, and it's your fault, you pay your deductible before the insurance company pays. Same way here. You're going to pay the full cost of your prescriptions until you get through the deductible phase of your prescription drug plan. A caveat, too, to mention is some drug plans offer Tier 1 and Tier 2 drugs free of cost.Zach: Gotcha, gotcha. So, that gets that deductible phase. And, like you said, moving into the initial coverage phase, hitting that $4,020 limit there on the coverage.Nick: Yeah, and one thing to mention a lot of people see this number and their eyes pop. They think they're going to be responsible for over four grand out of their pocket before they get through the second stage of their drug plan. It's important to remember that this cost consists of the cost you pay and the cost the drug plan pays as well.Zach: Yeah, yeah. You're not paying $4,000 out of your pocket. So, then, looking there, the third stage is probably the most popular stage. Everyone hears a lot about—people complain a lot about it because you pay more for your prescriptions, but you're looking at that doughnut hole, or the coverage gap.Nick: Yeah, so the technical term for this is the coverage gap. But what the—everybody refers to this as the doughnut hole, you're correct. And the reason the doughnut hole can be such a bear is for people that have higher, more expensive medications, their cost-sharing within this period goes up pretty substantially. So, basically, the way it works, when they get in this period, for prescriptions, they've been paying X amount; in some instances, that price can double, until them, the manufacturer of their drugs, and the prescription drug plan provider has a maximum out-of-pocket cost of around 6350 bucks. And it's important to mention also, I think people should know, in a lot of cases, most people don't get this far in the drug plan gaps. But for people—we see a lot on insulin. We see people a lot on other specialty drugs, whether it's cancer drugs, Parkinson's drugs, things like that—individuals are hitting these gaps. So, it's good for them to know why it's happening, why their drug costs are increasing.Zach: Yep, definitely, definitely. And so then coming to the close there with the four different phases, there is that light at the end of the tunnel there at the catastrophic coverage phase.Nick: Well, yeah. There's some good in the bad with this phase. If you make it this far down the drug plan cycle, it means you spend quite a bit of money out of your pocket throughout the year. But also, when you make it to this point, this is the lowest your costs are throughout the whole plan. You're responsible for no more than 5% of the total cost of your drugs when you make it this far. And one thing to mention Zach, I think just to wrap this section up, prescription drug plans run January 1st through December 31st. So, if you elect a plan later in the year, your plan will restart January 1st, whether it originally started in December or January of the previous year. So, these limits all reset starting January 1st of each year.Zach: Definitely. So, we put everything in for you guys at start the annual enrollment period, it does show us what the average cost is going to be based off your current prescriptions and pharmacy, as well as when you're roughly going to hit each phase. So, we're going to be able to tell you when to expect to hit that doughnut hole, or if you're going to hit it at all, or when you hit that catastrophic phase moving forward there. As we come to close there in our first part there, the ABC of Medicare with the prescription coverage, just keep in mind they are a pretty finicky thing out there. We do the best we can, but like I said, not be able to tell the future, we can usually work with what we have in that time period.Nick: Absolutely, absolutely. And it's important that people realize, when you run a prescription drug plan proposal, it's based on the prescriptions that you're taking at the current time. We obviously can't read the future. We do the best for people with their current list. Sometimes throughout the year, there are changes, and hence this is by far the biggest product that we get complaints about across the board, Zack.Zach: All right guys, and welcome back to our next session here, our interview portion of episode three on PDP, prescription drug plans, and we are happy and lucky to be joined on the phone by Tausha Mitcham, National Sales Director for Aetna working on their MA-PD, PDP side of things. And so, Tausha, thanks for jumping on the phone here with us. I know where you're at, it's pretty early in the morning.Tausha: Oh, it certainly is. Yeah. Thanks for having me. I appreciate it. [laughs].Zach: No problem. No problem. Thanks for joining us here. So, as I said, Nick and I've got a few questions here about you in regards to the PDP prescription drug plans there. Kind of help some people out there out that are listening to our podcast.Tausha: Okay, sounds good.Nick: All right, Tausha, we'll jump right in. So, first question that I would have for you is if a drug plan beneficiary is taking, or prescribed a drug that isn't on their plans formulary, what can they do to try to get the plan to cover that?Tausha: Sure. So, it's pretty simple. What they’d want to do is they want to go to their doctor and request a special exception. That's really the key. Always work through your physician as it relates to any special process and exceptions.Zach: Very good. So, a lot of people in our market, they like to travel; we call them snowbirds, you know, they'll live up north, go down south when it cools off, to try to stay there. So, what is a—as a beneficiary, they're out of their service area, if they’re wanting to look for continuous amounts of time, what's the best way to go about that with the networks and things like that?Tausha: Oh, absolutely. So, really, the key to that is using a national drug chain. So, it's going to be a drug chain that you would have in any state. So, generally, those are going to be CVS, Walmart, drug chains like that. And, of course, you want them to be in-network.Zach: Yeah, we always try to make sure when we're running PDPs for our clients, you know, making sure—a lot of them like those little local drugstores; we try to get them to at least check the big chains out there in case they do travel.Tausha: Absolutely.Nick: Very good. So, Tausha, what types of quantity limit programs can insurance companies use to limit the amount of particular prescriptions a client can get at a time?Tausha: So, quantity limits [unintelligible] from your insurance carrier and that would mean your doctor must be involved. So, try this before you go to any brand name drug.Nick: Okay. Very good.Zach: So, what are some of the benefits for a Medicare beneficiary taking a prescription drug plan even if they don't take any prescriptions? And we do talk to some people out there that don't take anything; what's the best route for them? What would you recommend?Tausha: Sure. So, essentially what that does for them, it keeps them from having to pay a late penalty for enrollment. So, I mean, ideally, if they had a plan that protected them from it, that would be one thing, but if that's not the case, and they just don't think that they needed the prescription, by actually picking up a PDP plan, it will keep them from having to pay the late penalty, the enrollment penalty. And I could tell you what that is if you'd like me to.Zach: Sure.Tausha: Okay. It's 1% of the current national base beneficiary premium, multiplied by the number of uncovered months. So, let's say you decide 24 months down the road, you're looking at this 1% of the current national base. Again, the beneficiary premium multiplied by the number of uncovered months, and then that's rounded to the nearest 10 cents. So, for 2020, the national base premium is 32.74.Nick: Very good. Thank you.Tausha: Sure.Nick: And, next one I have for you here, Tausha—and you kind of alluded to this a little bit earlier, but I just want to put a spotlight on this—when it comes to a client choosing a pharmacy to fill their prescriptions through a particular PDP provider, what is the benefit of choosing a particular pharmacy as it relates to cost or maybe access?Tausha: Sure. So, again, key, key, key is always to choose a preferred pharmacy for lower drug costs. That's always the key.Nick: Right. Very good.Zach: So, as we're getting close to wrapping it up here, we've hit the high notes on prescription coverage and everything out there. Is there's any other information you would like to share with our audience about prescription drug plans?Tausha: Well, I will tell you, as it relates to Aetna and CVS, we are super excited about a new plan we are coming out with for 2021 that's called the Smart RX plan. And nationally, the plan is $8 and under. So, obviously, it varies based upon state, but none of the plans will be over $8 a month.Zach: Wow.Tausha: So, we're extremely excited about that. And again, that's a national network, and we talked about going to those chains. Obviously CVS would be an in-network provider for that.Nick: Right. Well, last one, Tausha. Give us a little bit of information about Aetna. Any exciting, other changes coming for 2021? Floor is yours.Tausha: Okay, great. Well, thanks for the opportunity. So, a few things just to know for 2021; you've heard about our Health Hubs. Generally, you're going to see those in CVS pharmacies. In some cases, you'll have a Health Hub that's located inside of a Target because there is a CVS within that target. But our plan is to actually have 1500 of our Health Hubs nationwide by the end of 2021. And what that really does is it helps with additional care for in between a member’s doctors appointments, that's really where that's going to be beneficial for your clients. Also, CVS is now allowing patrons to use PayPal, which I think is pretty cool. And then possibly in the future, they might be able to use Venmo as well. We've expanded into 158 counties, with one new state, 288 D-SNP expansion counties with nine new states. We've done an HMO production expansion nationally. And then we have a new veteran's plan is called the Eagle Plan, and 88% of our members are in [four plus star plans]. Aetna CVS is all about caring for the whole member, and really our focus through that is through a Medicare Advantage Plan—which could be an HMO or PPO; SilverScript Part D, which is what we've been talking about—our pharmacy plans; D-SNP special needs plans; Medicare supplements; and ancillary products, which with you would be like a hospital indemnity, cancer and heart attack, home health care, and more. And then lastly, I just really wanted to just highlight the support that CVS Aetna has given around COVID-19. We waived all COVID related copayments, and I think what's probably stands out the most for me is that we opened multiple COVID-19 testing sites throughout the United States where we kind of had those hotspots. And CVS acted quickly and implemented those hotspots to help with testing. So, thanks for the opportunity to talk about our highlights for 2021.Nick: Super cool, Tausha. Super cool. Sounds like Aetna CVS has a lot of exciting things coming for the coming year.Tausha: Absolutely. We're very excited.Zach: All right, Tausha. Well, thanks again for getting on here with us and answering these questions. Like I said, we know it's a little early out there for you, again, so we want to thank Tausha with Aetna for joining us and answering some questions for us.Nick: Thanks, Tausha.Tausha: Right. Thank you.Zach: All right, so for this episode's product review, we're going to be looking at drug plans. So, there's not a lot out there when it comes to drug coverage outside of these government-ran prescription plans in the Medicare market. So, Nick and I are going to walk through looking at what all we look at when we're talking to clients to find the best plan for them, and also what they need to have with him to make our jobs easier. So, Nick, starting off, what's the process for getting people signed up?Nick: That's a great question, Zach. Really, the process on our end is, first, an individual has to have a qualifying election period to enroll. We touched on that a little bit earlier: whether that's their initial enrollment period to Medicare; whether that's the annual enrollment period, October 15, through December 7; or you mentioned slightly earlier about other areas that people might be able to enroll, special election periods. They have to have a valid election period first. And then once they have a valid election period, really our job is to ask the right questions, to collect the right information, whether that's the prescriptions they're taking, the dosages that they take, frequencies they take them, how they fill their pharmacies, whether it's mail order, whether it's brick and mortar at a retail pharmacy, all of those things, Zach, go into helping us find the person the right prescription drug plan.Zach: Yep, definitely. Yeah, we want to make sure we're getting the right one out there for them. So, you know, we sit them down, here's the table, got our client across from us. What does our client need to make sure they bring in with them to make our job easier and find the best plan for them?Nick: Well, the medical industry has been recommending that the senior market carry a list of their prescriptions that they're currently on in the event of an emergency for some time now. So, that, of course, is the first thing that we would ask a client to bring in. More importantly, to apply for prescription drug coverage, they associate your Medicare card information with prescription drug plans. So, a Medicare card would certainly be something else that an individual would want to bring in. And then, ultimately, it's our job to once again, ask the questions, get them in the right plan, and make sure we get them covered.Zach: Yep, definitely. So, you know, they’re sitting here in front of us, we got all their paperwork out, we've put the prescriptions in, we’ve put their pharmacy in they go to for getting the right network and everything. The last little part here, kind of touch on what all we're looking for when selecting the plan because, like I said, our goal is we want the best plan. We know going in that number one complaint in Medicare is these prescription plans, so we want to do everything on our end to cut those down short of, you know, not being able to tell the future, and know if you're going to get something prescribed different down the road, but what we have in front of us to work with. What are we looking for to get them the best coverage?Nick: Yeah. And before I answer that, Zach, I just want to go back and touch on one thing. You know, with these prescription drug plans, all companies have different plans that they promote in different areas. So, when we're asking individuals all these questions about the particular prescriptions they take, the frequencies they take them, and the dosages they take with them, the reason for that is we want to make sure that we find the right plan for them. So, we get the question all the time—you've been asked this 1000 times, as well, “Why this plan?” So, getting back to the question that you asked, really the three things that we're looking at, initially we're looking at the deductible: does this plan have a deductible? The premium: what's the cost of this plan? And then ultimately, what's it going to cost an individual to fill their prescriptions each month, when they go to these facilities? And there's multiple factors that go into those monthly costs. All these drug plans partner with different networks of pharmacies, so we want to make sure not only are we getting their prescriptions, their dosages, their frequencies, we want to know where they're filling them. We also want to know if we can find a cheaper option to send them to fill their prescriptions. Are they willing to do so? So, with all of that information, what it gives us the ability to do, Zack, is we can plug this in, we can find them not only the cheapest drug plan from a month-to-month premium costs, but overall we can find them a plan that has the cheapest costs throughout the year filling their prescriptions. So, for some people, they may take very basic medications, they can get a $13 a month drug plan that covers Tier 1 and Tier 2 on zero copays, or they may have higher cost drug plans that are $57, $65 bucks a month, but it eliminates the deductible phase for that client so they have level costs throughout the year. So, ultimately, it allows us to find the right drug plan for our clients with their particular mix of medications that they're currently taking.Zach: Definitely, yep.Nick: One thing to point out as we bring this to a close is the reason we get lots of complaints about this, Zach, is because, throughout the year, individuals have changes in their medication. And each drug plan covers different medications under their formulary. So, unfortunately, when we run a proposal for our client, we're running it based on their current list of prescription drugs, whereas if those drugs change throughout the year, that may change their proposal. So, unfortunately, our hands are tied in that regard. Medicare is who dictates when people can make changes throughout the year. If you have any questions, reach out to us, we'll do everything we can to help out.Zach: All right, so for this episode's Medicare Confessions—as you guys know, Nick and I like to share a few real-life stories so you guys can kind of see how what we're covering is working in the real world, know that we're not up here just making things up as we go; what we're doing is actually helping and impacting people out there.This episode, Nick and I both have some examples we want to share. First one I want to share is we're going to call her Miss Sally just for protection of her name, and where she's at, and all of that. So, Miss Sally was in her 70s and still working. So, she was on her group coverage, everything with work; only had her Part A of Medicare. She was diagnosed with a catastrophic illness. All of a sudden, she's having to pay hundreds of dollars for prescriptions, thousands of dollars for treatment, things such as that. She gets put in contact with me. I talked to her, we walk through, she decides it's going to be better for her to go onto Medicare and get a prescription plan. And by doing this, she saves hundreds of dollars on prescriptions, thousands of dollars on treatment because this takes care of her deductibles and her copays. Because, as we've talked about in the prescription plans, the various different thresholds and phases, she goes through, got through them, unfortunately, pretty quickly, but was able to hit that catastrophic phase, and save a very good chunk of money. That's just one way that we were able to help people, we were able to find what worked best for her in a very unfortunate circumstance. But was able to help her not lose any coverage and not lose any prescription that she was having to take but get them at a much cheaper price.Nick: Absolutely, Zach, we see that all the time. I've got several scenarios that I can share here, from individuals going from group insurance to Medicare; Medicare prescription drug plan to Medicare prescription drug plan. So, the first instance, I had an individual similar to you, that was working, still working beyond 65, 68 years old, and she got diagnosed with cancer, which put her on some pretty expensive Tier 4 and Tier 5 medications. On her drug plan that she had through her retirement, she did not have access to local pharmacies. They weren't in-network, so she was filling her prescriptions on standard or non-network pharmacy bids. So, we were able not only to get her over onto Medicare and a supplement to pay her health insurance bills but by getting her on a Medicare prescription drug plan, we were able to link her up with a preferred provider pharmacy, we were also able to cut her drug costs almost in half overnight, so that was wonderful.And then another client I had was going from Medicare to Medicare. They had a Medicare supplement plan and an individual prescription drug plan, but they were filling scripts once again at not-network pharmacies. So, by linking her up—in this case, we were able to keep her on her same prescription drug plan but sent her to the right pharmacy, also saving her quite a bit of money. So, the thing to keep in mind is that not only can we save people money, a lot of times with prescription drug plans, but if you're going to the right pharmacies—or mail order, in some instances—pharmacy’s costs differ from place to place. So, it's nice to make sure that where you should be filling your prescriptions to get them at the best cost.Zach: We want to thank everyone for listening, and a big thank you to Tausha with Aetna for jumping on here with us and answer some questions on prescription drug coverage for us. You know, again, as we're getting close to the annual enrollment period, great time to be looking into your prescription coverage, reviewing your options, as everyone's prescriptions, they change throughout the year. So, the only time you can change those are during this annual enrollment period. So, got any questions about your prescription coverage, looking at different pharmacies, Nick or I would love to review the options, everything out there for you. Make sure you're getting the best drug plan for your prescriptions at the pharmacy you're going to. Just remember, you can email us at firstname.lastname@example.org or give us a call, 844-437-4253. Remember, guys, annual enrollment period shows up, that's the best time—and only time—to review your drug plan options. So, until next time, guys, have a good day and God bless.Nick: Take care.Announcer: Thank you for listening, and we hope you found this episode informative. If we answered your questions, odds are you aren't the only one wanting to know. So, please share this episode with your friends and family. If you enjoyed this episode, please subscribe and rate our show on Apple Podcasts, or wherever you listen to podcasts to catch all of our episodes. If you want more information, or want to talk directly with Nick and Zach, you can call them at 1-844-437-4253. You can also find them on Facebook at facebook.com/seniorbenefitinc or on their website. seniors-livinghealthy.com. Thanks for listening, and have a great day.
26 min 38 sec
Some of the highlights of the show include: What Medicare Part B is and what it covers What the government considers “credible coverage” What happens when you have credible coverage and what happens when you don’t How much Medicare Part B costs on average How Medicare Part B costs vary on a person-to-person basis How chiropractic care can lead to a healthier lifestyle The impact stress can have on your spine and your organs What the Torque Release Technique is in chiropractic medicine How it’s never too late to begin treatment with a chiropractor Some of Dr. Sara’s tips for staying in shape and living a healthy life as we age A brief primer on hospital indemnity plans and what they’re designed to cover How Nick and Zach help clients build hospital indemnity plans that meet their unique needs A few case studies on how hospital indemnity plans have helped Nick and Zach’s clients save money And more! Quotes“Think of Part B as covering everything outside of being admitted to the hospital. Medicare has no referrals. Lab work, physical therapy, CAT scans, MRIs, ambulance rides, emergency room visits if not admitted to the hospital, and homecare in a limited basis, are all covered under Part B.” — Nick“Medicare Part B has an 80/20 coinsurance, meaning Medicare pays the first 80% and you're responsible for the remaining 20%. The coinsurance takes effect after you have paid an annual deductible of $198 per year. Once the deductible is paid in full, you're responsible for 20% of all remaining charges.” — Nick“Part B of Medicare pays for diabetic testing supplies. Insulin, pills, diabetic medications are covered under Medicare Part D, but the testing supplies themselves, folks, are covered under Medicare Part B.” — Nick“Medicare is actually a pretty favorable insurance when it comes to chiropractic coverage. Typically, the only thing that is not covered within Medicare is examinations and/or X-rays if those are taken.” — Dr. Sara“The cool part is we are removing that pressure, and putting those bones back in the proper place. It allows your brain and your body to connect and actually function optimally, and as that happens, for one, a person gets out of discomfort while at the same time that means that the organ system is also thriving and starting to optimally function.” — Dr. Sara “The goal of our podcast is helping people prepare for retirement, whether that be 65, 70, 75 whenever that is.” — Zach“If you get up into retirement age, and you have all the money in the world, and you want to travel, you want to do all the things you want to do, yet you don't have your health, what do you have?” — Dr. Sara“I call it a Build-A-Bear plan, just because it is a very flexible plan. It's got a couple of different base parts of the policy you pick, and then it's got several riders that you can add on.” — ZachLinks: Freedom Chiropractic Facebook Instagram TranscriptAnnouncer: Welcome to our fireside chat with Seniors Living Healthy, the podcast that helps prepare and educate you as you enter and live out your golden years. With over 10 years of experience, Nick and Zach are experts in the senior market and are here to help you live a healthy, full life. And now fireside with your hosts Nick and Zach.Zach: Hello, and welcome to episode two of our inaugural season of Seniors Living Healthy. Again, I'm your host Zach, and here with me is my co-host, Nick.Nick: Hello. Hi folks.Zach: This episode, we're going to go over Part B of Medicare which covers your outpatient care. So again, as I'm sure that you've guessed, this episode’s ABC of Medicare is going to be Part B, medical. So, once you turn 65, you're going to be able to elect to take this Part B as long as you don't have credible coverage, Nick, tell them what the government considers credible coverage.Nick: Credible coverage is determined by the level of coverage offered under the plan, and the number of employees covered by that plan. Among other things, if you are turning 65, or intend to retire soon, reach out to your HR benefits department to see if you will have credible coverage when the time comes.Zach: That's great, Nick. And so if they don't have that credible coverage though, and they don't take their Part B, and pass on it, why don’t you tell them what they're going to win by not having that credible coverage?Nick: Yeah, absolutely. Okay. So, once an individual goes eight months after they stop working, or employer coverage ends, whichever is first. They will be penalized by Medicare and that penalty is 10% of the full cost of the standard Part B premium, each year they go without coverage. Also, after that timeframe, there is a limited window, Zach, that a person can apply for Medicare benefits. It's what's called the general election period. It typically runs January 1 through March 31, with coverage beginning in July of that year.Zach: Gotcha. So, they let you elect it, kind of, sort of—Nick: On their timeframe. Yeah, you got it.Zach: Yep. Yeah. So, they tell you you don't have to take Part when you turn 65, but if you're not covered, you kind of have to. So, now that we've covered how you get your Part B, what all is that Part B going to cover for you once you receive it?Nick: Yeah, so Part B is outpatient coverage. So, folks, you can think of Part B as covering everything outside of being admitted to the hospital. So, meaning any type of services outside the hospital that are medically or Medicare-approved are covered under Part B. Some of those common services, Zach, we see things like doctor's visits, whether primary care or specialist—Zach: We're going to have to have a referral to see those specialists though?Nick: Oh, great question. We hear that quite frequently. Medicare has no referrals. Absolutely. Lab work, physical therapy, CAT scans, MRIs, ambulance rides, emergency room visits if not admitted to the hospital, and homecare in limited basis, are all covered under Part B.Zach: Great, great. So, now we know what they cover. We had that deductible on Part A we talked about last episode. Is it similar here with Part B or, kind of, how—what are they going to cover for us?Nick: So yeah, great question, Zach. Medicare Part B has an 80/20 coinsurance, meaning Medicare pays the first 80% and you're responsible for the remaining 20%. The coinsurance takes effect after you have paid an annual deductible of $198 per year. Once the deductible is paid in full, you're responsible for 20% of all remaining charges. And remember, just like Part A, Part B is a nationwide program designed for Medicare beneficiaries; no networks associated, and just like you said, no referrals necessary.Zach: Great, great. So, as we know from last month's episode that Part A, we paid into when we were working. So, Part B, we elect to take it, we haven't paid anything to it, yet. Nothing in life is free. How are we going to get that covered?Nick: Yeah, so absolutely. So, you're right. Nothing in life is free. This is a topic we run into quite frequently. One of the first questions people ask is, “What's it going to cost? I'm new to Medicare, what's it going to cost?” So, the answer is very simple: it differs. There is a standard Part B premium, that is $144.60 for the year 2020, however, the amount people pay varies widely. Some individuals pay nothing for Part B, some individuals pay the standard premium, and people making over $500,000 a year actually are paying $491.60 per month, Zach, so it varies quite differently. Most of these premiums begin the first month your Medicare goes into effect, and reach out to your local social security office to figure out what your Part B will cost you if that's something you're worried about today.Zach: Gotcha, that’s great. So, I know we talked about the quick overview of what all Part B is going to cover, hit some highlights there, but I know there's a few things out there that Part B covers that not a lot of people know, or people use them on a daily basis and knowing that Part B is going to cover that's going to be a huge help for them. You want to run through those for us real quick?Nick: Sure. So, the two common services that there are a lot of confusion about what are where it's covered are durable medical equipment and diabetic testing supplies. I know you and your clients, Zach, you've been doing this for a number of years, this is a question we get asked all the time. “Who pays for my diabetic testing supplies? Who pays for my strips, et cetera?” Very simply, Part B of Medicare pays for diabetic testing supplies. Insulin, pills, diabetic medications are covered under Medicare Part D, but the testing supplies themselves, folks, are covered under Medicare Part B. And then the other one there, Zach, is durable medical equipment. So, that's nebulizers, oxygen tanks, wheelchairs, crutches, you name it. All the medical equipment is also covered under Part B, meaning after the $198 deductible is met, clients are responsible for 20% of all those costs.Zach: Definitely, yep. That's a big part there with that Part B, what all it covers, especially those diabetic testing supplies. That is probably one of our top two or three questions we do get.Nick: Absolutely, absolutely. So, in a nutshell, that's Part B.Zach: Hello, and welcome back. We're here on the phone with Dr. Sara with Freedom Chiropractic here in Knoxville. How are you doing today, Dr. Sara?Dr. Sara: I'm doing wonderful. Thanks for having me on.Zach: That’s good. Thank you so much for joining us. Like I say, we're going to jump on in here with our interview part of our segment. And so we have Nick, as well, is here with me, so he's going to get the ball rolling for us.Nick: Sure, absolutely. So, we'll jump right in Dr. Sara. So, first of all, our first question for you would be what does Medicare cover when it comes to chiropractic care?Dr. Sara: Yeah, that is the favorite question from everybody, which is amazing. Medicare is actually a pretty favorable insurance when it comes to chiropractic coverage. While a lot of times, within our world, chiropractic is a little bit more of a preventative focus, and so it can be less length of time to which they will cover stuff in some instances, but typically, if somebody would come into our office, the only thing that is not covered within Medicare is going to be any examinations and/or X-rays if those are taken. But otherwise, actual chiropractic service can have some really decent coverage with that. In our current office, we do a complimentary benefits check to make sure to see what is actually covered, if there's any supplementals, and if there's anything extra we need to know about that specific client. So, we would do all that, and before we—at least for us specifically, we’d let everybody know what that insurance coverage is for the length and period of time that they would be under our care, prior to them actually getting adjusted.Nick: Very good. Very good. And just a quick follow up on that. Dr. Sara. In general, are referrals needed for individuals with Medicare?Dr. Sara: No, they typically are not. At least for us, we have a lot of people that are calling in from either just, like, family referrals, or a doctor is recommending a chiropractor, or physical therapist is recommending one, but also just a lot of people are just looking for another option. And so yeah, it does not need a referral, but if you have friends and family that are interested in chiropractic care, we would love to definitely take care of them.Zach: How can chiropractic care help you live a healthier lifestyle?Dr. Sara: So, I just want to talk a little bit about just, like, what chiropractic is, and how the body works a little bit to explain that question. So, the way that our bodies work, your brain and your spinal cord control and coordinate every single function in your body, and it does so from the top of your brain down to the rest of your system out through those nerves to every single cell, tissue, organ within your body. And so, over the course of our life, we have this crazy thing called stress happen. We're all in a season of incredible stress, currently. And just within that type of stress, your body has to do something with it. And so what can happen with those bones within your spine, it actually can shift them out of alignment. And so when they're out of alignment, it can cause pressure, irritation, even damage to the nerves that are then trailing to the rest of your system. And so not only can you have pain, but you can also have organ dysfunction. So, we have a lot of people that do have a lot of reoccurring chronic pain and or acute pain, while at the same time have organ dysfunction, like digestive issues, or thyroid issues, or sleep dysfunction. And a lot of those types of things, they don't really necessarily think chiropractic can help, but—so the cool part is we are removing that pressure, and putting those bones back in the proper place, it allows your brain and your body to connect and actually function optimally, and as that happens, for one, a person gets out discomfort while at the same time that means that organ system is also thriving and starting to optimally function. So, if you're not in as much pain, it also gives you an opportunity to live your life and to do the things you want to do. I have people that have goals that they just want to pick up their grandbabies, and play around, and go travel, and do all these fun things without being in as much pain as they were in. So, that's our hope is that we can get people to that stage and actually see them have that type of change within their health.Zach: Kind of following that one up, as we know, you do a little bit, not your traditional chiropractic care.Dr. Sara: Yeah.Zach: Kind of explain what you guys do over there at Freedom Chiropractic that’s different than a lot of other chiropractic places.Dr. Sara: So, a lot of times, chiropractic is presumed to be a manual type of an adjustment where the practitioner is using their hands to actually physically move a bone back into place, and I am definitely on the pro side of all chiropractic works, 100 percent. I am a proponent for having people definitely find what jives with them. We are very different. We'd actually don't use our hands to adjust, we use a technique called Torque Release Technique that allows us to be able to assess the actual nervous system, and then we use a small handheld tool called an integrator to actually administer the adjustment. And so the beautiful part about that is it allows us to be incredibly specific. It is FDA approved, the tool that we use actually adjusts at one ten-thousandth of a second, so it's really fast while it's also incredibly gentle. So currently, in our office, our, actually, oldest practice member is actually 93 years old, and we get to be able to use this technique where it's not going to be hurting anybody; it's really gentle, but at the same time, it's really specific to the actual stress that spine is carrying. Yeah, it's definitely different, but at the same time, all chiropractic does work, for sure.Nick: Okay, great. Well, the next question that I would have for you is, is it ever too late to start care? I mean, this flows great with the fact you said you're, I think, your oldest client currently is 93 years old, does that timespan ever run out?Dr. Sara: No. I think the only limiting factor that's going to run out—or potentially put a hindrance on somebody is whether or not they can get to the office. That's pretty much the only thing that's going to keep us from potentially being able to see them. But I mean, I've gotten to people's homes before, if it ever works to be able to do that, I've gone to a hospital before. So, situations like that can happen. But I always joke with people, if you have breath in your lungs, you can get adjusted, basically. Because, ultimately, if you have breath in your lungs, it means that you have a nervous system that is still functioning. And the gentleman that I mentioned that’s 93 currently, he actually started with me when he was 85 years old, and so he's been under care for the past seven years. He still golfs three times a week, does 18 holes. He came in the other day and was like, “I'm a little tired after golfing 18 holes.” I’m like, “I’d be tired if I golfed 18 holes, and I'm in my 30’s.” So, in the same sense, our hope and goal no matter the age or no matter how young we are is to be able to provide opportunities so that we can thrive within that age, within the body that we were given, for sure. So, definitely not too old. The older we get, unfortunately, life does continue to build and stress continues to have. So, we would rather have people get going no matter when, but never too late for sure.Zach: That's one of our sayings around here is, unfortunately, don't get healthier the older we get. That's for sure.Dr. Sara: Yeah, that's true. That's very, very true.Zach: And so, our goal of our podcast, as we've talked about, is helping people prepare for retirement, whether that be 65, 70, 75 whenever that is. What are some tips you may give to some of these people who listen to this podcast that are getting ready to go into retirement? They've been sitting in a desk nine to five every day or longer, and now all of a sudden, they're not going to be sitting at a desk, they're going to be able—they might go out and play golf three times a week. They’re going to be out doing some different things. What are some tips to keep in mind while preparing for retirement health-wise?Dr. Sara: Yeah. Just like you, I talk all the time to my people, if you get up into retirement age, and you have all the money in the world, and you want to travel, you want to do all the things you want to do, yet you don't have your health, what do you have? And that's such a big thing when it comes to our health because your health is, it literally is your lifeline to what you want to do with the money that you have for retirement, and/or what to play with your family, to play with your kids, whatever it may look like. So, definitely making sure your health is a priority within that, even though we tend to not take care of ourselves all the time. But taking care of yourself, that looks like drinking lots of water. I don't think people in our society drink enough water, ever. But they say that half your body weight in ounces of water needs to be consumed every single day, so that's a great place to start to keep yourself hydrated. If you've been sitting in a very stagnant position for a long period of time, definitely making sure that you're stretching. Getting on a good either stretch or yoga routine is fantastic. Meditation is fantastic. It's a great way to be able to connect just to the present moment. And then, walking. If you haven't moved a lot, I always start with walking, start doing some functional movements: squats, small push-ups, if you can do those types of motions. I'm a huge proponent for eating, obviously, really good veggies really good fruits. Good fats, get chiropractic care but limit those processed sugars, limit those processed breads and dairy, all that type of stuff, too. Those are going to be amazing things just for overall health when it comes to keeping yourself healthy, and keeping yourself active because I know for me I want to be 93 and be able to golf. I want to be able to do the things I want to do, but I have to take care of my body to be able to do that.Zach: Well, Dr. Sara, thank you for those tips. Hopefully, that will come in handy to our listeners out there. So, in closing if you just want to tell us where people can find you, and if they're interested, and we'd love to point some people in your direction.Dr. Sara: We are located right by West Town Starbucks, right over by where Classy Lady used to be, and across in Trader Joe's. That's where our physical location is. You can find us on Facebook at freedomKnox. If you just look up Freedom Chiropractic, you'd find us there. We are on Instagram as well, if that's something that people would like to follow us there, @freedomknox—the at sign—@freedomknox. Our website is also freedomknox.com. So, an easy way to just go get some more information, and kind of what you'd expect in our office as well, and just give you an opportunity to be able to see if it's something that would jive with you and your family, for sure.Zach: Perfect. Well, thank you Dr. Sara for giving us some of your time. I know you're pretty busy out there, and thanks for being able to jump on and answer some questions for us and help some people out.Dr. Sara: Absolutely. Thank you guys for doing what you're doing as well. It's a pretty amazing asset to be able to have for a resource for people, for sure.Zach: All right, so for this episode's product review, we're going to go over a hospital indemnity plan.Nick: Okay.Zach: Nick always gets a little chuckle out of this, I call it a Build-A-Bear plan, just because it is a very flexible plan. It's got a couple of different base parts of the policy you pick, and then it's got several riders that you can add on, and—kind of, we've talked about before, rider’s just a little something—you know they cost a little more on the premium, but they give you the added coverage for much cheaper costs than if you were to get strictly a policy of just that on its own. So, Nick, starting out, tell them why I call it a Build-A-Bear plan.Nick: Yeah, absolutely. Great title for the plan. So, hospital indemnity plans are very simply exactly what they say. They are designed, Zach, to cover when a person is in the hospital, to cover expenses that their plan or Medicare does not cover. So, initially the reason we call it a Build-A-Bear plan is this policy has two bases that you can choose from. And I know depending on the client, Zach, we typically choose different ways here, but the client can choose to get a daily indemnity payout, or they can choose a lump sum indemnity payout, meaning each time they're admitted to the hospital, they get a particular payout. Right?Zach: Exactly, exactly. So basically, once the client chooses what they want for their base, whether it's a lump sum or a daily, then we're going to review the different riders with them. This is where we, Nick or I, will really dig in, ask a lot of questions because we want to make sure we're building a plan to fit your needs. There's no need to add a rider that you don't need, but also, too, we don't want to have a rider that's a glaring need there, and we leave it out in the open. So, Nick, there on those riders, you want to run through them real quick and just tell them what's out there for those options to get the best plan available?Nick: Absolutely. So, there's multiple riders available on this policy, and as Zach alluded to, our job is to ask questions, determine the needs—or the lack thereof—that you may have, and that gives us an idea of which one or which ones of these may be the most beneficial. But the ones that this policy offers, Zach, are the outpatient surgery rider. So, if you purchase this rider, you have the ability to get up to $1500 paid to you or your designated beneficiary to cover the costs that your healthcare or Medicare does not.Zach: Definitely. I think that's one of the best riders on this plan.Nick: Yeah, absolutely. Depending on what type of health insurance you have in addition to Medicare, Zach, this certainly can be a very beneficial rider. And then the second one is doctor visits. So, everybody calls this the copay rider. This policy will allow an individual to purchase up to $50 worth of reimbursement each time they go to a doctor visit, whether primary care or specialists. This policy also offers an emergency room and ambulance services rider that will pay out up to twice per year $200 per payout; an outpatient rehab rider, this rider will allow you to collect an indemnity payout each time you attend rehab and incur costs it pays you; a daily skill facility care rider giving you a daily indemnity to cover the costs that Medicare or your insurance doesn't pay while you're admitted to a skilled facility, and last but not least, and most definitely most popular, Zach, is the new cancer and lump sum rider this policy is offering. This rider is becoming very hot, lots of people like it, and basically very simply it allows you to buy $2,500, $5,000, or $10,000 worth of lump-sum cancer coverage for a minimalistic premium.Zach: Oh yeah, and they added this one on to this plan, that was a game-changer—Nick: Sure. Absolutely.Zach: [crosstalk] by that kind of coverage. So, they're looking at, Nick, so this mentioned, being an indemnity plan, it's not really a true insurance policy which also allows it not to have any networks.Nick: Yeah, that's exactly right. So, when we think of insurance, we think of insurance cards, we think of all these big-name companies that we're used to. These types of policies aren’t traditional insurance. You're not showing these cards to your medical facilities. You're not showing these cards to your doctor's offices. What's happening is there's no networks because technically, the doctors never know these types of coverages exist. When you get your services rendered, they send you an explanation of benefits, and they send you a bill. You submit that to the insurance company for them to disperse your payout, whether directly to you or to a designated beneficiary that you may choose.Zach: Great, great. Yeah. Like I said, this is a very great plan to custom build it to fit your needs, and it works great with some other Medicare plans that are out there on the market that we'll touch more on in the coming months.Nick: Yeah, absolutely. Absolutely. There's a very common type of Medicare coverage out there that most of its biggest gaps are covered by this policy. So, with it in conjunction with a hospital indemnity plan, they can offer some good benefits, and we'll be covering that shortly in a following podcast.Zach: All right, so for this episode's Medicare confessions, Nick and I both have a couple of stories here I want to share with you guys about this product, just because we have written a lot of these, and they do work so well with Medicare. First off, Nick and I both have several clients that Nick alluded to in the last section. This plan works great with Medicare, and in this situation, these people weren't in their enrollment period where they could enroll in something, so by purchasing this hospital indemnity plan, they were able to get something to fill in the gaps until they could get a larger more comprehensive plan. And in many cases this paid off for them, they've had to go in for an outpatient surgery, they've had to go to a doctor visit, they've had to go to some type of physical therapy, something like that, and they've been able to use this plan to fill in some of the gaps that they're Medicare doesn't cover. So, we were able to help them that way, then come their enrollment period, where we'll look around, but then this hospital indemnity plan renews continuously, so they have both in place so then it keeps working for them.One client really sticks out to me and this is again for client protection there, we're just going to call her M, Miss M, just to go through this way. And she wrote her hospital indemnity plan several years ago, and several months back, she had a minor knee surgery. So, when she goes in, right there off the bat, she uses the outpatient surgery indemnity part of the plan. So, then after that—she was a little bit older—they sent her into a skilled care facility for a couple of weeks to work on her rehab, get that range of motion back before they sent her home. So, that was when that daily skilled nursing facility came into play. And then lastly, Miss M goes to regular physical therapy once she's home, and again, she's right there, she's using the outpatient rehabilitation rider. So, this was a plan that's very affordable, and something just as small as a minor knee surgery paid off large dividends for somebody like that. And these things don't have to be large and catastrophic, as you can see there. It can be some minor things. It'll put a little money back in their pocket.Nick: Absolutely. Minor things add up, too, when it comes to these types of coverages, Zach. So, two cases come to mind here. The first bought this policy and actually had an unintended positive impact. As we alluded earlier in this episode, this policy now has a new rider, the cancer lump sum rider. I had a client that was on a very minimalistic coverage, but didn't really have the opportunity, or wasn't in the correct time period to enroll in something more comprehensive. So, we put this policy in place with all the riders as well, trying to give them a little bit of everything type of coverage. Six months back, I get a call, the client had been diagnosed with cancer, we had assigned a $10,000 benefit rider for this policy. So, she got $10,000 to pay what Medicare would not for her chemo, for her treatment, for anything else that she decided to use the money for. Haven't spoke with her since, good Lord willing, she's doing well, but we're certainly glad that we put that in place. The other client that comes to mind, Zach, is an individual who very similar to your situation, fell, shattered an elbow, and had to have multiple outpatient procedures. This policy not only paid out maximum benefit of 1500 bucks when that happened but more importantly when she was released, she was released in a rehab facility, outpatient rehab, she did almost 12 weeks and was covered throughout based on this policy. So, she certainly gives us great reviews, gives the policy great reviews, and those are just a couple examples of people that have benefited from hospital indemnity coverage.Zach: We hope you enjoy the second episode of seniors living healthy and we hope that you got some useful information from it. Don't forget that Part B of Medicare is optional, which means you don't have to take it in order to receive Part A. The 2020 Part B deductible is $198 yearly, and the monthly premium is going to be on average $144.60. And don't forget your Part B covers diabetic testing supplies and various durable medical equipment.If you're a new listener and enjoyed this episode, go back and give our first episode a listen, where we discuss the ins and outs of your Part A of Medicare. Again, we would like to thank you for listening. We also want to thank Dr. Sara from Freedom Chiropractic here in Knoxville, Tennessee for joining us, again and answering some of our questions, and letting you guys know how chiropractic care and Medicare work together. We hope you guys have a great day and don't forget to subscribe and be on the lookout for our next episode where we’re going to cover all things Part D of Medicare.Announcer: Thank you for listening, and we hope you found this episode informative. If we answered your questions, odds are you aren't the only one wanting to know. So, please share this episode with your friends and family. If you enjoyed this episode, please subscribe and rate our show on Apple Podcasts, or wherever you listen to podcasts to catch all of our episodes. If you want more information, or want to talk directly with Nick and Zach, you can call them at 1-844-437-4253. You can also find them on Facebook at facebook.com/seniorbenefitinc or on their website. seniors-livinghealthy.com. Thanks for listening, and have a great day.
27 min 36 sec
Have a listen to learn: What Medicare Part A is The three different groups that qualify for Medicare Part A What Medicare Part A covers and what it doesn’t cover How much Medicare Part A costs How Medicare doesn’t have any networks or referrals for any physicians or medical facilities and what that means for Medicare patients How Medicare Part A covers 60 days of hospitalization and what happens on day 61 and beyond What happens when you keep working after age 65 and the associated insurance implications The options individuals who don’t qualify for Medicare still have The services BenchMark Physical Therapy offers for Medicare patients The most common kinds of ailments BenchMark sees in Medicare patients The kinds of clients Parkwest Physical Therapy sees each day Tips for how seniors can succeed with physical therapy activities What “wrinkles on the inside” means How recovery care is the favorite product that Nick offers and why And more! Quotes“If an individual has worked 40 quarters or 10 years and paid into Medicare, traditionally via payroll taxes, then they will automatically qualify for Part A. They will receive Medicare Part A on the first day of the month of their 65th birthday with one exception: if their birthday is the first day of the month, they get it the month prior.” — Nick“In a nutshell, Part A of Medicare is hospitalization insurance for individuals on Medicare.” —Nick“Keep in mind that Medicare is a nationwide program. So, Medicare beneficiaries, whether from California, North Carolina, Michigan, to Florida all have the same program.” —Nick“As we get older, our system just doesn't do what we tell it to do. Our brains try to tell our body what to do, and it doesn’t react the way it did when we were in our teens.” —Matt“Physical therapy is a commitment. It's a time commitment. It's a financial commitment. It’s a lifestyle commitment.” —Matt“I think the biggest hurdle for a lot of people is that it's so new. You're doing things that you've never done before. Everybody's gotten their routine, and some of the older population, they've been in that routine for 50, 60, 70 years. And so, turning things in a different direction is a little bit more challenging.” —Matt“You always want to wear loose clothing because you're going to be doing things physical.” —Kaitlin“Statistics say the average cost in a nursing facility of some sort is $72,000 per year. I would say there's a good chunk of people out there, especially in the market we deal in, that if you're retired, that $72,000 is probably pretty tough to come up with.” —ZachLinks BenchMark Physical Therapy: Parkwest Physical Therapy Centers for Medicare & Medicaid Services Senior Benefit Inc. TranscriptAnnouncer: Welcome to our fireside chat with Seniors Living Healthy, the podcast that helps prepare and educate you as you enter and live out your golden years. With over 10 years of experience, Nick and Zach are experts in the senior market and are here to help you live a healthy, full life. And now fireside with your hosts Nick Keene and Zach Haire.Zach: Hello, and welcome to episode one of our inaugural season of Seniors Living Healthy. I'm your host, Zach, and here with me is our co-host, Nick.Nick: Hello, folks.Zach: This month's episode, we will go over Part A of Medicare, which is hospitalization. So, as I'm sure you've guessed, this episode’s ABC of Medicare is going to be Part A, hospitalization. Most people are going to get that the month they turn 65 with a few exceptions, so we're going to jump right in. And Nick, why don't you tell us how an individual gets that once they turn 65.Nick: So, if an individual has worked 40 quarters or 10 years and paid into Medicare, traditionally via payroll taxes, then they will automatically qualify for Part A. They will receive Medicare Part A on the first day of the month of their 65th birthday with one exception: if their birthday is the first day of the month, they get it the month prior.Zach: Thanks, Nick. So, with that one exception, is there any other kinds of exceptions out there to Part A, how somebody can receive it, and when they can receive it?Nick: Absolutely, Zach, great question. So, if an individual doesn't qualify themselves for Medicare at age 65, they can qualify off a spouse, whether alive or deceased. Also, if an individual is under 65, but has been on disability, and received benefits for 24 months straight, they can also receive benefits, and then the third situation would be if individuals have been diagnosed with End Stage Renal Disease or ESRD, or Lou Gehrig's disease, they can also qualify for Medicare.Zach: Thanks, Nick. So, now we know how someone gets Part A; when they get it, how they can get it, what's it going to cover for them out there, once they receive it?Nick: So, Medicare Part A is listed as covering semi-private room and board, general nursing and miscellaneous services and supplies. So, in a nutshell, what Part A of Medicare is, is hospitalization insurance for individuals on Medicare. So, the way Medicare Part A works is it is designed based on a benefit period of 60 days, and when one is admitted to the hospital, they have a Part A deductible that they are responsible for, which is $1408 each 60-day benefit period.Zach: Now, is that deductible going to change depending on where they go to the hospital? You know, if they're out of town, they go to the hospital, is it going to be different? Are they going to have—how does that work for him?Nick: Yeah, so great question. Keep in mind, Zach, that Medicare is a nationwide program. So, Medicare beneficiaries, whether from California, North Carolina, Michigan, to Florida all have the same program. So, as long as they qualify for Medicare and it's in place, there are no networks or referrals for any physicians or medical facilities.Zach: Perfect that makes it nice being able to go wherever you need to go to get the [crosstalk] you need.Nick: Absolutely. Absolutely.Zach: So, in that 60-day period of care, when that 60 days up, does it start over again? How does that work? Break that down a little bit more for us.Nick: Yeah. So, the way the benefit period works, Zach, is the 60-day benefit period starts when an individual is first admitted, and continues as long as someone is receiving services, whether in the hospital and/or medical facility: things like skilled facility care. So, when they're admitted originally, they pay a $1408 deductible that covers them whether they stay in the hospital for continuous 60 days, maybe they leave the hospital halfway through, go to a skilled facility care then come back into the hospital: they're still covered under that same benefit period.Zach: Perfect. So, once that 60 days is up, what are they're going to get them for after that?Nick: So, Medicare has defined benefits, Zach, beyond day 60, that dictates how much someone on traditional Medicare is responsible for. So, if an individual is continually admitted, whether in the hospital or and skilled facility care, beyond day 60, day 61 through 90 will cost an individual $352 per day.Zach: That's a lot. Per day especially.Nick: Yeah, it can add up, but more importantly, if an individual is in there continuously beyond day 90, they have what's called 60 days of lifetime reserve coverage. Under the 60 days. They are responsible for $704 each day.Zach: Talk about a punch in the gut there, with that those prices.Nick: Sure, absolutely.Zach: So, looking there at it, Nick, let's say that I am getting ready to turn 65. I'm still working, or over 65 and continue to work. You have to take Part A, or can I just keep rolling with my company's group insurance?Nick: Yeah, great question. So, we field this question continuously as you know. With over 10,000 people turning 65 each and every day, people are constantly asking, “What do I do? I keep my group insurance, do I drop my group insurance, go on Medicare?” The simple answer is you have the ability to keep your group insurance without going on Medicare Part B. However, for today's topic, Medicare Part A is automatic.Typically, you've paid in throughout your career in the form of a payroll deduction, so the month you turn 65, you're automatically enrolled in Part A. One thing to know though, Zach, is if someone has group insurance, and they're going to continue doing it, they need to ask their HR benefits department, whether they will have Medicare as their primary, or whether they will have their group insurance as their primary. And one of the main things that dictates that, is the number of employees covered on that group insurance plan.Zach: Great, great. So, Nick, I know—kind of talked a lot about Part A, kind of getting it set in there. One of the things I wanted to point out there is, if you haven't worked your full 40 quarters yet, you are able to draw off your spouse. That's possible, but if not, someone that’s, let's say they don't have 36 quarters, and they're turning 65, so they're going to have pay for their Part A, are they still going to be able to continue to work and then, when they get those last four quarters off, quit paying for that Part A?Nick: Yeah Zach. So, let me give you a good answer to this question. For individuals that don't qualify for Part A of Medicare, they have the ability to purchase Medicare directly through Medicare. So, that is all based on the amount of hours they have worked and paid in throughout their life. So, for your example, if they worked 36 quarters, or nine years and paid in, they're responsible for four more quarters or a year before they qualify. They would have the ability to continue working, paying into Medicare while also funding Medicare Part A where they so wish.Zach: That's one of those situations where we refer somebody to go back to work.Nick: Yeah, yeah. It's good for the soul they say. But long story short, Medicare Part A is hospitalization. Different individuals qualify; covers when you're admitted to the hospital, Zach.Nick: All right, folks, we're here with Matt from BenchMark Physical Therapy. This is Nick, and I've got Zach with me here as well. We've brought Matt in; he is a local physical therapist, and we've got some questions we want to ask him that we think could be beneficial to you guys. So, we'll get started here, and see what Matt has for us.Zach: All right, man. Hey, this is Zach here—Matt: Hey Zach, thanks for having me. I'm happy to be here.Zach: Hey, no problem. We're glad we could have you. This episode, we've kind of been talking about different types of recovery care and things like that in the senior market. So, what are some typical services that you guys provide their BenchMark for Medicare beneficiaries, more in the senior market, everything?Matt: Sure. So, I would say that the Medicare population counts for a significant portion of our total patient population. Most of the time this patient population is going to be dealing with some type of musculoskeletal problem. It can be back pain, neck pain, shoulder pain, we see a lot of foot and ankle pain, plantar fasciitis, that kind of thing. As the population ages a little bit more, you start to see more concerning issues: things like generalized weakness and balance issues, things that the concern there is a fall. As we get older, our system just doesn't do what we tell it to do. Our brains try to tell our body what to do, and it doesn’t react the way it did when we were in our teens.So, really focusing on strength and safety first. So, our clinicians will prioritize their treatments based on certain risk factors with the age population. So, we do fall risk screens to really give us some information on when this patient goes home, what am I really worried about them? Were they going to be able to get on and off the couch, get on and off the toilet, getting in and out of the shower without slipping and falling down. And then, once we have a good feel for the higher risk problems, then we can start picking off some of those lower-risk problems.So, prioritize health and safety and balance, but then as we start to feel good about that, how does Nana get the dishes out of the cabinet, reaching up overhead? I think as we get older, we realize that aches and pains are going to be a part of our life, but can we maintain the lifestyle that we want to live in the way that we want to live it? And so, all of my therapists are very excellently trained in communicating with the Medicare patients, saying, “Hey, I see that this is what's hurting you. But let's also talk about what's limiting you, and what's important to you.” And specializing those treatments to the patient's needs and function, so that they can hold that grandbaby. Sure.Nick: Sure. Yeah, we hear that quite a bit, Matt. Quick question for you, just a quick follow up there. Speaking about some of these seniors, and maybe we call them their ADLs, activities of daily living, does someone have to have a referral to come see you guys typically, or can these individuals walk in and get care?Matt: So, that's a good question, and for decades, we were required to have an order from a physician for physical therapy until about, I believe it was in 2007, 2008, in the state of Tennessee, which is when we acquired direct access. And direct access means that anybody off the street can come into the clinic and get treated based on certain guidelines: you got to be making progress, and we have to follow up your physician a certain amount of days if we don't have an order. Unfortunately, the one insurance that does require an order, of course, is Medicare.If Medicare is your primary, in order to get them to pay for it, they do require an order. The good thing is all of our office coordinators up front are very well trained and versed in that, and so what it usually comes down to is Medicare patient comes into the door and says, “Hey, I've got this problem. Can I get on so and so’s schedule?” And then, a lot of times, if it's a physician that we know, or we have direct contact, we just reach out to him and say, “Hey, Miss Johnson has been telling us she's complaining of shoulder, you mind writing us an order?”Nick: Great. Great. Great. Yeah. And just I guess, really, the next question would be there, Matt, what are some typical services you guys do that may not be covered by Medicare?Matt: So, it's a good question. There's generally not anything that we do on a regular basis that's not covered by Medicare. There are, based on the way that we code, what we do, we have to do it a certain way, but there is no lack in care for a Medicare patient versus a commercial payer patient. We certainly have to modify the way that we do things, in terms of having one on one care versus having care with another patient as well, and those are some details that we have to work out as clinicians. But from a treatment standpoint, there is no difference between a Medicare patient and a commercial payer patient. Every service is provided the way that we would do it, regardless of payer. Whatever the patient needs, that's what we provide.Zach: Great. Thanks, Matt. So, looking there at it, in your experience we've, like you said, a lot of seniors, a pretty heavy market for you guys. For someone getting ready to come in for rehab, what is something that, to be prepared coming in, what should they be looking for? Is there something to help themselves get prepared, whether it be mentally or physically, coming in for that rehab?Matt: Physical therapy is a commitment. It's a time commitment. It's a financial commitment. It’s a lifestyle commitment. You have to do things in a different way than you have been doing them in order to resolve the pain, the functional limitations that you're dealing with. And the more that you commit to it, the better off you're going to be. And by better off, I mean, you're going to require less visits to come in—and this isn't just me talking, we've done a lot of research on it—“We” being BenchMark, but then “We” also being just the field of physical therapy—have looked at compliance to visits, compliance with home exercise program, and overall outcomes. And our outcomes are far better when we have somebody who comes in, does, the exercise at home is reliable.the commitment to the idea of it is, I think, the biggest hurdle for a lot of people because it's so new; you're doing things that you've never done before. Everybody's gotten their routine, and some of the older population, they've been in that routine for 50, 60, 70 years. And so, turning things in a different direction is a little bit more challenging. So, yeah, that's probably the biggest thing is compliance, and being able to know that we're going to commit to a different atmosphere of our life.Nick: All right, very good. Thanks for that, Matt. Well, I'll tell you what. Just kind of wrap this up a little bit. You are local to us. In fact, across the street from us. Tell us a little bit about what you do, and what your facility provides for our senior market here in Knoxville.Matt: Sure. So, the clinic that I am at is our North Peters location. It's in the Cedar Bluff area and is kind of our flagship for the Knoxville area. So, we have multiple services; our biggest patient population is orthopedics, as is most physical therapy clinics, so backs, necks, shoulders, hips, knees. We do post-operative treatments. We do see a lot of foot and ankle issues, so a lot of plantar fasciitis, a lot of toe problems, issues like that. But then beyond orthopedics, we have a pretty diverse platform of treatment. So, we see lymphedema management, which you're not going to be able to find—there’s just not a lot of locations around the Knoxville area; we see a big population of those patients. We have a lot of pediatrics as well, so maybe 100 kids or so a week come in for various issues, which really I absolutely love because I've seen it just light up our senior population in the clinic.So, we'll have a gym that's mostly full with 50-, 60-, 70-, 80-year-olds, and a three-year-old comes skipping in for her treatment with the occupational therapist, and it's just amazing to see that reaction from the seniors of just having that brief interaction with the kid, and how they can all instantly just not be worried about their issues. So, we treat a lot of pediatric patients. We do pelvic health as well. So, patients who've had prostatectomies or postpartum issues. So, we see, let's see, lymph, pelvic, pediatric.We do massage therapy as well. We have hand therapy as well. We have—this is a pretty diverse little group. We have a geriatric certified specialist. So, one of our clinicians is certified to treat this older population. We do dry needling. We do other soft tissue techniques. It's a very diverse clinic, and it's a lot of fun to be in the big open clinic. Everybody knows everybody, and we have the ability to kind of take patients in isolation and put them in private rooms if they are immunocompromised, but for the most part, most people are in the open and feed off of one another, and they have a tendency to really thrive on that social interaction as well.Zach: Yeah, sounds good, Matt. So, sounds like you guys have a lot that you can offer out there. I want to thank you for joining us, jumping on here and answer some questions for us, and definitely want to let everybody know if they're out there looking for a physical therapist, reach out to you guys over BenchMark.Matt: Yeah. We have, I think, 30 plus locations stretching across the greater Knoxville area, and excellent clinicians across the board. We have more certifications in BenchMark than any of the other physical therapy clinics in the area, and we've really tried to remain laser-focused on our safety during this pandemic situation. It is certainly a challenging time for everybody to be engaged in health care, but certainly the senior population, and we want to always make sure that they feel comfortable and safe in our environment. And we'll just keep it that way as long as it needs to stay that way.Zach: Perfect, Matt. Well, again, thanks for hopping on here with us. And l say, guys if you need anything, reach out to Matt there at BenchMark.Matt: Yeah, I really appreciate you guys giving me some time today. Y'all have a good one.Zach: Hey, you as well. Thanks, Matt.Nick: Take care, Matt.Nick: All right, folks. This is Nick here in the Seniors Living Healthy podcast with my co-host Zach. And we have Kaitlin with us from Parkwest Physical Therapy today. We've asked her on to answer some questions for our market, and let her give her insight. Kaitlin, thanks for being with us today.Kaitlin: Yeah, no problem.Nick: All right, great. Well, we'll jump in here; get started. What are some typical services you provide for the Medicare market, the senior market?Kaitlin: So, like you said, I'm a physical therapist at Parkwest, and we cover quite a variety of different services that we have available. A lot of things, I guess, that we see as far as seniors go, we see everything from joint replacement to stroke, even Parkinson’s, or just the regular neck, back pain, all the way to balance therapy as well. So, we cover just about everything. We're a relatively large clinic. So, between all probably 14, 15 therapists, we all kind of cover quite the variety of different things.Nick: In general, what portion of the people that walk through your door are in the senior market?Kaitlin: Probably anywhere from at least 50 percent on. Probably 50 to 75 percent, maybe. We only see occasional, really young, like, under 18. And the majority of our patients are probably of the senior population.Zach: So, kind of looking there with the senior market, somebody's getting ready to come in, what do they need to do to be prepared physically, mentally, what to look for when they come in.Kaitlin: So, of course, your clothing is going to be a big part. So, you always want to wear loose clothing because you're going to be doing things physical. So, as far as comfortable clothing goes, you want to be comfortable in moving around and what you're coming in wearing. But as far as the mental aspect of it. I think a lot of people have the mindset that every time you come to therapy, it's a no pain, no gain kind of mentality, but that's not always true. I mean, sometimes of course, when you have joint replacements and things like that, there is going to be some pain that goes along with that. But not every single case that a person comes in for physical therapy is there a no pain, no gain mentality.I know a lot of times, for a lot of my patients, if that's painful, let's back off kind of thing. So, a lot of times people come in with that mentality. The first day is going to be more of a, let's figure out where you're at, what we need to work on. It's a lot of talking and more of the evaluation part of it. And be sure to come in with questions. Go ahead and ask your therapist, “What should I expect? What is the plan? How are we going to meet X, Y, and Z?” As far as what to expect for your treatments to come, after that first evaluation. And don't be afraid to come in with your own goals. Say, “I want to be able to walk this distance,” or, “I want to be able to do this, that or the other.” Be sure that you're coming in with, “Where am I at? Where do I want to be?” And you're vocalizing that with your therapist.Zach: Definitely, yeah. I've had a few rehabs with my knee. And mental is a big part of it. Getting there knowing what you want to do going into it.Kaitlin: Yes.Nick: Very good. Very good. Well, how about this, Kaitlin, what are some ways for seniors to stay healthy from a physical therapist standpoint?Kaitlin: From a physical therapist standpoint, it's all the things that you probably hear all the time: stay active, stay moving. I know we always get those wrinkles on the inside, is what I call them, so good ol’ arthritis, or you'll hear all these diagnoses that have all these crazy names as far as degenerative disc and all these types of things, but if you stay moving, and keep those joints moving, and stay active, even if you have to get in the pool to stay active, just keep moving, keep hydrated, balanced diet, but really just stay moving. Motion is lotion, I guess is what we say.Zach: Perfect. Thank you, Kaitlin. So, just kind of wrapping it up here, tell us a little bit more about you and your facility there with Parkwest, what you guys have to offer, and everything that's out there.Kaitlin: Sure, sure. So, I went to East Tennessee State. So, I got my undergrad and my doctorate from East Tennessee, and I've been with Parkwest coming up on three years now. And I myself just recently got, it's a pain certification. So, I'm a therapeutic pain specialist which is an upcoming thing that a lot of people aren't familiar with, I guess I should say. So, that is kind of my little niche is chronic pain, and treating pain of all sorts. It’s my little niche that I've kind of started there at Parkwest.But as far as services go and what we offer, we have everything from aquatic therapy, we have hand therapy, we treat vertigo, we also treat Parkinson's, with the LSVT BIG and LOUD programs, and that's both with physical therapy and speech therapy. So, we have therapists there that are certified in that. We have therapists certified in McKenzie. And then, we also do pelvic health, and TMJ dysfunction as well. So, we have quite a wide variety as far as specialties go. But I myself, work in with the aquatic, and I do a little bit of everything. I'm probably the girl Friday of the clinic. I do a little bit of everything, but I am over our aquatic program, and then kind of getting started on our pain management program as well.Zach: Gotcha. Well, perfect, Kaitlin. We want to thank you for taking some time out of your day to speak with us, and share what people can look forward to in going into therapy, and what to expect, and what your facility can provide. And like I said, definitely, anybody here in the Knoxville area, reach out to Parkwest, and I'm sure Kaitlin and all of her cohorts would be more than happy to help you guys out.Kaitlin: Yes. Thank you so much for having me.Nick: Take care, Kaitlin. Thank you.Zach: Thanks, Kaitlin.Zach: All right, for this episode's product review, we’re going to go over recovery care. Here at Senior Benefits, we work with several different companies, a wide variety, and portfolio of products. So, we chose recovery care for this episode, just because it really fits well with Part A of Medicare and what it covers, and we think it's a great product for clients. This is actually Nick's favorite product that we offer.Nick: That's right.Zach: And so, since Nick has a great love for this plan, we're going to let him break it down some for us. So, first off, Nick, what exactly is it going to cover for them?Nick: Yeah, that's a great question, Zach. So, recovery care is an insurance policy designed to cover in addition to Medicare, or in some situations cover where Medicare doesn’t. Recovery care kicks in when an individual is assigned to a nursing home, or assisted living facility, and can't do two or more activities of daily living, or is diagnosed with a cognitive disorder. One thing to mention, Zach, I know we talked about this earlier today, is unlike Medicare, there is no requirement of prior hospitalization for this policy to pay.Zach: Great, great. That's a big help there, too, not having to go to the hospital for those three days and whatnot to get basically permission to go into the facility there. So, now that we've kind of broken down what exactly it is, where all is it going to going to cover? I know one of the big things you like about this is because it—as you can break down for us—it's going to cover basically all three steps of recovery.Nick: Yep, absolutely. Absolutely. So, recovery care itself is designed to pay a daily benefit when an individual meets the policy’s requirements for a predetermined number of days. The policy’s requirements very simply are an individual has to not be able to complete two or more activities of daily living or be diagnosed with a cognitive disorder. And, as Zach alluded to, this policy is designed for all three levels of skilled care. So, that’s skilled, intermediate, and custodial. The important thing to point out is this policy will pay out for people in assisted living facilities, as well as custodial care nursing homes. Medicare pays nothing for either portion. I know you have past experience with the nursing home portion of this, Zack. What did they pay for your grandmother?Zach: Big fat zero.Nick: Zero. Absolutely. Same thing for assisted living. It's not determined to be medically necessary, so therefore Medicare pays nothing.Zach: This is a great plan to—almost a non-traditional way for a long term care plan of old, long term care plans today is quite expensive.Nick: Yeah. Especially in this market.Zach: Oh, yeah, definitely. This is a much cheaper way to get coverage out there if you were to go into long term care. So, looking at there, Nick, we've kind of said it's not a traditional insurance, so how does someone either pay the facility or get paid to pay the facility?Nick: Yeah, so this policy is a traditional indemnity style policy. There is no insurance card, the providers are not actually billing the insurance companies. The way this works is the policy has a defined benefits to it, Zach, and the policy, when a service is rendered, pays out directly to the policy owner or in some instances, the policy owner can assign the benefits under this policy to any type of medical facility, doctor's office, hospital, etcetera. A couple things to point out on this product, Zach.The reason I like it so much is this policy will actually pay for skilled facility care, intermediate, and custodial. So, what we find is not only will this help people pay when they're moved into skilled facility care, but it is giving people the opportunity to move into assisted living while being covered, without having to go into full-fledged nursing homes. We see later on down the road that over 70 percent of people 65 and older are using some sort of skilled facility care, and an overwhelming portion of those people do not want to go into the nursing home. By having this policy, it will allow you up to a year worth of benefits to go into assisted living while maintaining some sort of personal life.Zach: Definitely. Yeah, this is, like I said, a great plan to look into. Statistics say the average cost in a nursing facility of some sort is $72,000 per year. I would say there's a good chunk of people out there, especially in the market we deal in, that if you're retired, that $72,000 is probably pretty tough to come up with—Nick: Sure.Zach:—versus, planning in the long run, these types of plans definitely can fill in those needs for you.Nick: Absolutely. And lastly, Zach, let's not forget to point out this policy comes with the ability to purchase a home care rider. So, traditionally, Medicare covers home care in some limited instances, but with this policy, the only qualifying events are that medical professionals have to come out at least three times per week for a one hour visit, and the home care rider will actually pay up to $1200 per week for the insured, and a statistic is $44,000 is what traditional home care costs on an eight-hour basis. So, it adds up quickly.Zach: Oh, yeah definitely. This is why it's a great plan like I said. You can use it from a knee or hip replacement, gets you in the hospital with your surgery all the way to working your way back home with rehab, or if you were to have even something more catastrophic, whether a stroke or something like that and need longer-term care, this is definitely a great product for you.Nick: You got it.Zach: All right, for our last part here is going to be our Medicare confession. This is where Nick or I are going to share some stories with you. Clients we deal with on a daily basis, they deal with a lot of this stuff, so we see where these products, where the parts of Medicare, things like that, we are seeing where these work in daily lives. And we think this would be a great part to bring to you guys so you can actually see how this stuff works on a daily basis, not just us telling you about it: it actually working. So, for this Medicare confession on this first episode, Nick has a client that is going to use the recovery care. And he's going to tell us a little bit about it just based off of safety protection for them. Not going to use their name or anything, but he is kind of wants to share with you how he's had a client that had a recovery care plan, and it paid off big dividends for him in the end.Nick: Yeah, Zach, that's a great point. As we sat down, thinking about this podcast, this client’s story came to me very clearly. So, for the sake of security, we're not going to mention the client’s name, I'm simply going to refer to them as CP from here on out. So, just kind of moving into the story, guys. The way it worked is CP, unfortunately, fell down some steps and broke both her arms back in September of 2019. She was hospitalized for four days, and released directly, post-surgery into skilled facility care. So, luckily, CP had purchased a Medicare supplemental policy from us a couple years back, so all of her hospitalization and surgery was covered, but the recovery care portion came in once she was released. So, without the use of either hands, CP was unable to perform multiple activities of daily living for some time until she regained the use of both of her arms. So, because she had purchased a recovery care policy from us, and couldn't perform several ADLs, she was able to collect $200 per day. She was in the skilled facility, which added up to almost $6,000 by the time she was released. Now, not only did she have Medicare and a supplement that paid the majority of her bills, but by having the recovery care policy, she was able to pay the rest of the portion as well as take several thousand dollars home in the meantime. So, this policy for her certainly paid good dividends.Zach: Definitely, definitely. That's one of those times when you like to hear—we never want to hear anybody getting sick or hurt, but it is always nice we know we've helped somebody, and we can hear those stories what we've helped them do has paid off and is working for him.Nick: Absolutely, absolutely. And just to point out, I spoke with CP several months back, and she has ultimately still been going through physical therapy, but through the purchase of a home care rider on this policy, she has been able to continue that therapy at home: hasn't had to go to medical facilities, and the policy has been paying for her to do that, as well.Zach: We hope you enjoyed our first full episode and we hope you got some helpful information from it. Remember, as long as you or your spouse have worked 10 or more years, once you turn 65, you're automatically eligible for Medicare Part A, or you can draw from a deceased spouse or an ex. Part A of Medicare is going to cover your hospitalization and the deductible for 2020 which is $1,408. Don't forget that no matter what coverage you have, you will get this at age 65. We'd like to thank you for listening, with thanks to our guest, Matt Smith from BenchMark Physical Therapy, and Kaitlin Wallace from Parkwest Physical Therapy at Fort Sanders. Hope you guys have a great day and don't forget to subscribe. And be on the lookout for our next episode; we're going to cover all things Part B of Medicare. Thank you and stay safe.Announcer: Thank you for listening, and we hope you found this episode informative. If we answered your questions, odds are you aren't the only one wanting to know. So, please share this episode with your friends and family. If you enjoyed this episode, please subscribe and rate our show on Apple Podcasts, or wherever you listen to podcasts to catch all of our episodes. If you want more information, or want to talk directly with Nick and Zach, you can call them at 1-844-437-4253. You can also find them on Facebook at facebook.com/seniorbenefitinc or on their website. seniors-livinghealthy.com. Thanks for listening, and have a great day.
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