2023 Medicare Enrollment is here: What you should know!

Episode Transcript for Ep-1921

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Announcer

And now America's Healthcare Advocate,

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Cary Hall

CaryHall. Hello, America. Welcome to America's Healthcare Advocate show broadcasting coast to coast across the U.S. Our producer, a Mr. Sean Floyd. I'm your host, Cary Hall. This is your show, America. Thank you for joining us and making us one of the most listened to talk shows throughout the United States, by the way.

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Cary Hall

We are on all of your favorite podcast platforms now. So they're all out there. I don't care what it is. We're on it. There's about 15 of them now that we're on. In addition to that, we're on YouTube. We're getting a lot of people downloading these shows. We had 58,000 people download the podcast in the last six months, so we're pretty excited about that.

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Cary Hall

This continues to grow. All of you listening on the radio, all of you to go up to the podcast platform, all of you that are on YouTube, the YouTube hours are up to something like 250,000 views. All of you out there looking at these shows and downloading. So we're glad that you like them. Obviously, we hope the content is engaging and that's why we do this.

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Cary Hall

So if you are looking for help with Medicare, if you are chronologically challenged, I happen to have three people in studio today. The lovely ladies from RPS Benefits by Design. And we're going to talk about Medicare, but I'm going to give you the phone number and the information in studio today. With me is Joyce Thompson, Maria Ahlers and Carolee Steele.

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Cary Hall

the team from RPS Benefits by Design anywhere in the country, they can help you. The phone number is 877 385 2224 For the website RPS Benefits by Design Inc dot com is the website. If you want to send them an email if you need help. I don't care where you are.

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Cary Hall

They're more than happy to do it. They have offices across the country and they're happy to help you. So now that I did that, let's just go to the show. Hi, Carolee.

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Carolee Steele

Hello, How are you Cary?

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Cary Hall

I'm good. Glad to have you back. Hello Maria.

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Maria Ahlers

Hi Cary.

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Cary Hall

Welcome back in studio. Hello, Joyce.

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Joyce Thompson

Hi, Cary.

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Cary Hall

How's the lovely Joyce Thompson

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Cary Hall

the lovely Joyce is fine.

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Cary Hall

All right. So the purpose of this show today is to basically dive into Medicare and try to give you help educate you on. It's a confusing issue for a lot of people. You know, I had somebody call me and said, you know, I went up and I tried to look at this thing on the government website and I can't make heads or tails out of it.

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Cary Hall

Well, you've got an alphabet soup. You've got Medicare A, Medicare B, Medicare C, Medicare D, Medicare, F, Medicare, G, What does all that mean? How does it apply to you? Some of it does. Some of it doesn't. That's why we're doing this show. We're going to help you understand that. We're going to tell you what resources these folks have that can help you.

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Cary Hall

That's we're going to do. So let's just start with the definition of Medicare Part A Carolee.

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Carolee Steele

Part is hospitalization. It's well, and first of all, Medicare is a federally sponsored plan, running coverage for people who are eligible. And there's a certain type of eligibility, too. I'm going to go over those. Yeah, please. Okay.

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Carolee Steele

Individuals turning 65 who have participated in Social Security or Railroad Retirement Board benefit, they are eligible for Medicare individuals under 65 who have had been awarded Social Security disability and they've had it 24 months on the 25th month.

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Carolee Steele

They are eligible for Medicare.

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Cary Hall

Now, that's when a lot of people probably don't know if you're on disability now, you have to wait till the 25th month. I don't know what you're supposed to do for the first 24 when you don't have medical coverage from the 25th month. They then roll over to become eligible?

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Carolee Steele

They’re eligible for Medicare. Okay. And of course, in this situation, if you have ALS or end stage renal disease, you can immediately get Medicare as well.

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Cary Hall

Okay. So that's Medicare Part A, which is hospitalization Joyce Let's talk about Medicare Part B.

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Joyce Thompson

Medicare Part B is the next step to original Medicare and B equals your original Medicare. The B is for copays to see the doctor. Different things that you wouldn't get from A would be on the B it's awarded through the Social Security Office and slash Medicare.

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Cary Hall

Okay, so let's let's just start with B then. So. So but in order to get B Carolee, they have to go sign up, Correct? Okay. Well, I think a lot of people get confused about that. They get intimidated by it. Now, I did it and like I said, if I could do it, a chimpanzee could probably do it.

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Cary Hall

So so, you know, my skill levels on the computer are about there.

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Carolee Steele

But unless you have unless you already get Social Security and then they automatically send you your part A and part B, you can defer it if you want, but they automatically send you when you are enrolled in Social Security when you already have subjects.

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Cary Hall

Okay. But but if you if you don't take Social Security until you're 70, you know, whatever the case may be. So so let's go through the enrollment process and what the time frame is. When can I enroll in Part B? There's three, three times. Let's talk.

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Carolee Steele

About that. How to enroll in Medicare. You have an initial enrollment period. You've got the three months prior to your 65th birthday month. Correct. The month of. And then you have the three months after. Okay, That is the time that you can apply for your part in part B.

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Cary Hall

Right? So that that is what's important to understand. It's three months before the month of and three months after people get really confused about that. What happens if you miss that window? You don't do it at all.

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Carolee Steele

Then you actually start to incur penalties the government does want you to get B unless there are other circumstances, if you have employer coverage, etc. But if you just decided not to get Medicare, you would start to incur some penalties.

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Cary Hall

And you mentioned something there. Let's kind of we're going to hopefully this won't confuse you, but if you're you know, I saw an article in the Wall Street Journal day 658,000 people are now working in their eighties, which is really quite remarkable. A lot of people thought that was pretty funny when I sent that out. Some of the people in this room, actually, because I'm 74 now.

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Cary Hall

Okay. And the question was, yes, I will be working when I'm 80. But the point is, if you are working, let's say you're working and you're 80 and maybe you're working at Home Depot, or maybe you're working, you know, wherever and you got health care benefits, should you sign up for part B?

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Carolee Steele

It completely depends. And that's why you really have to rely on us to inform you. There are so many moving parts to this. If you have an employer plan that and you only have 20 employees on there, it's a different scenario then 20 plus. And so it really kind of depends. That's where we come into play. We'll be able to assist you on whether or not it's wise for you to stay on your company plan or to go straight to.

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Cary Hall

Medicare and see. This is the thing that you need to understand. You know, you see those those commercials on television. You know, and you've got the celebrity spokesman up there, you know that, you know, one day he's selling gold and the next day, you know, he's selling supplements or something. And now he's telling me all about Medicare. And then you call that number and you get some high pressure salesperson on there that their sole interest is to get you signed up for something and close that sale.

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Cary Hall

We're on the phone. This is completely different. People call you guys. You said, I know, I know Joyce, and I know you. I sit on those phones sometimes for an hour with people going through their options, explaining to them, and then they get to go back and digest all that and say, yeah, I just I'm going to stay on my employer plan because maybe I've got a prescription drug that under Part D, I'm going to have to pay more for whatever the case may be.

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Cary Hall

I'm going to go in the donut hole. We'll talk about Part D here later. But the point is, you all explain that to them. That's the difference.

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Carolee Steele

And it's not a one size fits all. That's the biggest thing is everybody like my uncle said, to do this, this and this and it's not necessarily true.

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Cary Hall

Or my next door neighbor told me, Yeah, that's the other one you get. Yeah. Oh, I heard this when I went to the Kiwanis meeting. Well, no, that's probably not the way you want to do it. So the idea then, Carol, is to give them information so they can make it good.

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Carolee Steele

Absolutely.

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Cary Hall

Yeah. Yeah. The other thing, it happens, Maria, is, you know, again, a lot of people do this. They call that one 800 number. They get signed up for something and then these people disappear. You're now you got a claims issue or a doctor issue or Dave and I were talking before on the air today about a bill he got okay that he probably shouldn't pay.

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Cary Hall

It was for an anesthesiologist bill. It's probably an out-of-network anesthesiologist that was brought in to do anesthesiology that bill he should not pay that well. They're sending in the bill and tell them to pay it. If that happens to one of our clients, what happens?

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Maria Ahlers

Yeah, well, we actually will reach out and advocate on your behalf. We'll look at the bill will make and we'll look at your plan and make sure to determine if you should pay that bill or not. And then we'll contact the carrier and advocate on your behalf to get that bill corrected.

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Cary Hall

Yeah. So we're not telling you to call the ‘1 800-I don't give a damn’ number because that's what I call it. Okay. With a lot of these carriers where you go on, you go through 15 voice prompts and you're trying to get somebody to explain to you, Why did I get this bill that I'm covered? Here's my plan.

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Cary Hall

It says it's paid for, but it's not. Well, probably the reason was because that particular physician didn't bother to submit that for an EOB and they just turned around and sent it to you for you to pay. EOB would be the explanation of benefits if you didn't get an EOB with it. That means they didn't submit it to the carrier for payment.

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Cary Hall

They just singled it out and sent it to you. You're not going to know that. These three ladies know that. Okay. And you heard Maria say it. They're your advocate. They call the carrier. We have a little different process than you calling is the pedestrian in trying to get through to somebody to help them. Talk about that a little bit.

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Maria Ahlers

Well, and Cary sometimes they code the service incorrectly.

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Joyce Thompson

So know.

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Cary Hall

That.

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Joyce Thompson

Happened.

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Cary Hall

Same thing that happened to my wife two weeks ago. Yeah. The lab, they they coded incorrectly at KU. Yup. Yeah.

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Maria Ahlers

And so then we have the experience and the expertise to look at it and go, okay, what did you get done? And this should be covered under your, your plan. But again, we'll reach out to the carrier, the providers and help get that corrected.

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Cary Hall

Get it straightened out. And that's really a key part of this. We come back to the break. We'll now talk about, you know, what is Medicare Part D George started down that path. So we'll go back to that and then we'll go through some of these other components. Stay tuned. You're listening to America's Healthcare Advocate. Broadcasting here on the HIA radio network Coast to Coast across the USA.

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Cary Hall

We got more. Stay right there.

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Steve Kuker

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Cary Hall

Welcome back. You're listening to America's Healthcare Advocate show broadcasting coast to coast across the USA here on the HIA radio network. You can find out more about us by going to the website of Americas Healthcare Advocate dot com. If you've got a question, comment, whatever the case may be, send me an email. Also, if you want to go up that maybe you want to tell somebody, hey, you know, you really need to listen to this show because they're explaining all this Medicare information and maybe you're getting ready to retire or maybe you've got maybe, maybe your spouse is going to be 65.

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Cary Hall

You're not vice versa. This is an opportunity to learn how to approach this and some of the ins and outs of how Medicare works. So that's what we're doing here today. My producers, Mr. Shawn Floyd, I'm your host, Cary Hall, in studio with me, the lovely Carolee Steele. Maria Ahlers and Joyce Thompson, all from RPS Benefits by Design.

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Cary Hall

If you want to reach out to them, it's 877 385 2224. That is the phone number. The website RPS Benefits by Design Inc dot com and they'll be happy to help you if you send an email just tell them when you want to contact them. What is it you're interested in? Medicare, ACA, whatever it is they're happy to help you with that.

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Cary Hall

All right, Joyce, let's now go to this Part D prescription drug and talk about how Part D, first of all, when do you sign up for it and do you sign up for it separately? How does all that work?

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Joyce Thompson

Okay, Part D, there's several different periods that you can sign up for Part D, just like with the Medicare Advantage plan. One of the special enrollment times would be AEP. It comes around every year from October 15th through December 7th, and that's when you can apply for Medicare Advantage plan or the Part D. The Part D is for prescriptions.

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Joyce Thompson

So each each company has their own plan for Part D, they're several companies, but the Plan D does the same thing.

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Cary Hall

So like UnitedHealthcare, Blue Cross, Aetna, Humana, they all.

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Joyce Thompson

Have.

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Cary Hall

D, but they're all the same because they're regulated by the government.

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Joyce Thompson

Exactly. And they have to work the same way. The only thing different could be deductibles out-of-pocket max, and premiums. That's why it's best to see a broker when you get ready to do this because you can't make a mistake and then you're stuck with that plan. So we do advise you to call us. We make an appointment, you come in and then we're going to put it all in front of you.

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Joyce Thompson

All right.

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Cary Hall

Staying in the Medicare Advantage plan, the Part D is included inside the plan.

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Joyce Thompson

The plan? And that's one of the benefits to a Medicare Advantage plan that D is in the plan. And Part D, like I say, you can get that from Aetna, UHC, different places. Well, that goes with the supplement.

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Cary Hall

Okay. So if you're so if you're on a “med sup” like I am, you have to buy a standalone Part D, So I have a Blue Cross and Blue Shield Medicare supplement but I have an Aetna Part D prescription drug because the formulary works better for us. And we're talk about that here in a minute. The formulary works better for us on that.

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Cary Hall

So, Carolee talk a little bit about the formulary. And I said, you know, we want you to come in and sit down. You ask them to bring in their prescription drug list. Right. Or, you know, if you're if you're in Phoenix, if you're in New Mexico, if you're you know, you're you're in Nashville, Tennessee, you can do all this by Zoom.

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Cary Hall

You can do it all on the phone. Just you need to have your list ready so they can look at the formulary and do what?

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Carolee Steele

Well, usually all formularies have like tiers. So different Tier one and two are typically the generic or the preferred generics. And then you get into brand names and then specialty drugs. Okay. So everyone is different, like a husband and wife. The wife may take two generic drugs. Her husband may take you know, he may be insulin dependent. And it really depends.

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Carolee Steele

So we will figure out what is the best separate Part D drug plan according to the medications that they take. So we usually ask for the name of the medication, the dosage, and then the frequency because of that actually comes into the end of the equation as well.

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Cary Hall

So if they're considering doing a Blue Cross plan versus a United Healthcare plan, it's a Medicare Advantage plan that could factor into which one of those two they chose.

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Carolee Steele

Absolutely, because not every carrier has them in the same tier across the board. There may be a somebody may have a drug at tier two and the other one will have it at Tier three. And there's a higher pre higher cost to that Tier three. So that's what is a consideration.

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Cary Hall

So what is the donut hole? I mean, it's not a place where if we go to Dunkin Donuts and get the little donut holes they put in the bag, I get those on Saturday mornings for my men's group. But, but so talk about the donut hole.

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Carolee Steele

Donut hole, Yes. That is also called the coverage gap. So there is a initial enrollment. So it's whatever medications you take, it's the carrier, it's the retail cost. So it's whatever the carrier pays and you pay up to $4660. Anyway, when it gets to that, that's when you hit the coverage gap or the donut hole and you are have to pay for 25%.

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Carolee Steele

The co-pays change. It's 25% of all drugs except for insulin. There are new programs in there where they kind of cap in a $35 co-pay for a lot of those dependent insulin injection. And then when you get to 7400, it goes to a catastrophic phase.

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Cary Hall

Okay. Do you see why this is confusing? Are you listening to this? Okay. If you think you can do this on your own, good luck. And if you want to go up on the government website and try to sort it out, you better have some Tylenol next year because you're going to get a headache by the time it's done.

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Cary Hall

That's what these folks do. They're experts at this. Okay? They can take your formula and go through and say, you know what? Yeah, the United plan, maybe that looks a little better over here on the on this side than the Blue Cross plan. But I'm looking at the Blue Cross formulary. Your drug is tier two here. Over here on United, you're tier three or you're out of pockets.

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Cary Hall

Going to be X, Okay, So those are the things you don't know. Okay? And those are the things they do know. All right. So that makes a huge difference is being able to explain to people and dive into the details here and get them what they need in a way that's going to make sense.

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Carolee Steele

And to piggyback on choices as far as Part D, that October 15th and December seven. So that's when you can change your part D, right? Because the carrier might come out with your plan, had a tier two and it bumped it up to a tier three. So what we can do is we can look at all of the other carriers and all of their party drug plans and see if that some other plan fits.

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Cary Hall

So you're on a Medicare supplement like I am. That's your chance to move your D If you want to move the Part D to a different carrier or you heard what they said, it's always wise to have them look at it at the end of the year and say, Hey, you know what? They've changed the formulary and this drug costs less or it's going to cost more and you need to know that.

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Cary Hall

So the idea being that you need to have somebody evaluate this and tell you if it's the right thing to do, stay put or if it's the wrong thing to do, it's time to get off of it. If you're on a mid sub, that's definitely going to be the case that you want to take a look at that If you're on Medicare Advantage, when you want to evaluate the whole Medicare data thing.

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Carolee Steele

The whole thing.

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Cary Hall

Yeah, it's because these things change.

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Carolee Steele

Every year.

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Cary Hall

And this year we're going to have change because there's a 1% cut coming out of CMS. It was going to be 3%. But I think a lot of people with hair, the color of mine raised a lot of hell when they heard that. And all of a sudden now the Biden administration has decided we're not going to do a 3% cut one year, we're going to do 1% over three years.

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Cary Hall

So we don't think the impact of that's going to be great, but there is going to be an impact.

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Carolee Steele

Yes. And we just have to October 1st is when the plan information comes out. So we take a look at that across the board. How they, are they heavy medical utilizers of the services, are they? And so we looked specifically for them as an individual of what's best for them.

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Cary Hall

Okay. You're going to see changes this year. That's why we're doing this. Part of the reason we're doing this right now, you know, here's July, right? And we're talking about what's going to happen on October one. They're going to know the plan designs by probably September. Okay. They'll have they'll have drafts of the plan, design something carries that about.

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Cary Hall

Right. Three months. So they'll actually know what's going to be there. You need to take the time to take your plan and have them take a look at it and see if it makes sense to state or it makes sense to move. And that's what they're going to do if you give them a call 877 385 2224 or the website RPS Benefits by Design Inc dot com.

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Cary Hall

Stay tuned. When we come back to break. We're going to get into some areas we haven't talked about yet for folks that have special needs. Stay tuned. We'll be right back after the break. You're listening to America's Healthcare Advocate broadcasting on the HIA radio network Coast to coast across USA.

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Cary Hall

Welcome back. You're listening to America's Healthcare Advocate show, broadcasting coast to coast across the USA here on the HIA radio network. You know, if you are a provider out there, if you're a if you're an M.D., if you're a chiropractor, if you're a physical therapist, if you're a neurologist, whatever the case may be, you probably ought to take a look at a website called Neurologic.life, Neurologic dot Life.

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Cary Hall

So what you're going to see when you go up there is a program called the WAVi Brain Scan, which was invented by a four time Nobel laureate contributor, Dr. David Oakley, and David Jaffe, who invented that little thing they put on your finger when you go to the E.R., the urgent care, that's who these people are. So here's what the WAVi Brain Scan can do.

00;21;00;11 - 00;21;23;07

Cary Hall

This is just some of it concussion protocol. If you've got a child that's had a concussion and you're going to put him back out to play, how do they know he's ready to go? Oh, he fills out a piece of paper called the Concussion Protocol. Well, that's going to determine whether he can go play. If he had a WAVi brain scan, you'd have a picture of his brain that would tell you he or she is ready to go play or they're not ready to go play.

00;21;23;07 - 00;21;43;07

Cary Hall

That's one of the things it can do. It can also help people that are pre Alzheimer's or dementia. This is another thing you do early detection, PTSD, anxiety and sleep. The website Neurologic dot Life, CPT codes covered 100%. You can submit it through the health insurance plans or cash page, whichever way you want to do it if you're a provider.

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Cary Hall

Once again, the website neurologic.life.

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Cary Hall

All right. So let's let let's switch gears now and talk a little bit about special needs. All right. This is a very unique category. We just started working on this this year. There's three categories for special needs. And see if I'm getting forget this, right, Carolee, chronic conditions. Correct. So heart failure, type one diabetes can qualify.

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Cary Hall

Those are the kinds of things that would qualify on Medicaid. So if you're on Medicaid, you get Medicare, but you can get a special needs program. We're talking about. Why would you do that? You'll see in a minute. And then if you're in a nursing home. So now maybe it's your mom. She's nine years old. She's in a nursing home or assisted living facility.

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Cary Hall

This plan can make a big difference. So let's talk about special needs and how United Health Care has got a great program. It has got some programs. Let's talk a little bit about that, Carolee.

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Carolee Steele

And I think it's so important to know because a lot of people, especially the dual special needs, that's one you talked about with Medicare and Medicaid. A lot of people have both. And they said, well, well, that's fine because they cover whatever Medicare and Medicaid covers it, but they're leaving a lot of benefits on the table. We're talking a heavy amount of dental and vision, hearing services, transportation, over-the-counter products, and it's a substantial amount for those who are dual eligible.

00;23;07;03 - 00;23;24;00

Cary Hall

So on a regular Medicare Advantage plan, Carol, there's co-pays for everything, correct? Correct. Okay. So across the board, you've got co-pays. You've even got co-pays for primary care, right? Choice? That's correct. All across the board, the only thing you don't have co-pays on typically is really going to get your colonoscopy or those things. But otherwise, you've got co-pays.

00;23;24;07 - 00;23;47;19

Cary Hall

Let me tell you about the co-pays. So I'm looking at the United Health Care plan. Here are the co-pays, the column of co-pays on here for everything from monthly premium, zero primary care, zero specialists, zero inpatient hospital, zero outpatient, zero home health care, zero lab emergency room, urgent care, all zero brand or generic drugs, zero co-pay. Okay. Yeah.

00;23;47;19 - 00;24;08;10

Cary Hall

You gets better mail order. Yeah. Again, you're zero co-pay now, you know, Carolee, we just mentioned some of the things that are available, $230 a month to buy healthy food, $230 a month to buy healthy food. You can't go to McDonald's, which I think you get the message or get dental benefits, $4,000 of dental benefits.

00;24;08;10 - 00;24;08;28

Carolee Steele

That's huge.

00;24;09;03 - 00;24;25;03

Cary Hall

I mean, that's bigger than what you get on a typical health insurance plan. Okay. Yeah. Zero co-pay for routine transportation. So if you're that person who's partially immobilized or whatever the case may be, maybe you just don't want to have to deal with driving to the doctor or the hospital. They'll provide.

00;24;25;03 - 00;24;28;02

Carolee Steele

Transport. And some people on Medicaid don't have cars that helps them.

00;24;28;02 - 00;24;38;25

Cary Hall

And that's a routine hearing, $3500 if you need a hearing aid, $3500. And then obviously you have an opportunity to go to the gym. These benefits are so rich.

00;24;38;27 - 00;24;39;15

Carolee Steele

Very rich.

00;24;39;18 - 00;25;00;21

Cary Hall

I mean, so it really would behoove people if you're talking to maybe this is your mom, your grandmother, you know, your uncle, your aunt, whatever the case may be, it's either got a chronic condition or maybe in a facility. And a lot of folks in rural communities, the heaviest used of Medicaid, Maria is in is in the rural communities.

00;25;00;24 - 00;25;15;10

Maria Ahlers

That's right. That's right. They don't have as much access to to them. I'm sorry. They just don't have enough access to to the plans in the network, as they should. And Medicare really does help.

00;25;15;13 - 00;25;35;09

Cary Hall

Yeah. And and in rural communities, a lot of people are at the poverty level or below because the opportunities for employment are not the same. Especially. And who states in these rural communities typically it's the older people because the younger people are leaving. So now what happens? It spirals down. You just heard Maria said they don't have the kind of care they need.

00;25;35;11 - 00;25;52;14

Cary Hall

Okay. So let's say you're you're up in Cameron, you're in Bethany, Missouri, okay. Or you're in Tupelo, Mississippi, whatever the case may be. But the doctor in the specialist you need to go to is an hour away. You're going to get a car and drive an hour. If you're 85 years old, 90 years old, and you've got a condition, oh, you don't have to because they'll come and get you.

00;25;52;18 - 00;25;54;13

Cary Hall

That puts you in a specialty van and take you.

00;25;54;13 - 00;25;56;08

Carolee Steele

Right, Carolee? Correct. Transportation is zero.

00;25;56;10 - 00;26;18;01

Cary Hall

And they'll pick you up and bring you back. So I guess what I'm trying to get across here is if you're a caregiver, okay, if you're if that's your mom or your dad, maybe you're in another state and they're you know, you know, this is going on, you need to reach out to these people and they're specialists. This is what they do, have a conversation with them about, does my mom qualify for this?

00;26;18;01 - 00;26;39;11

Cary Hall

And I'll tell you another thing. For example, heart conditions like the one my wife has don't qualify in Kansas, Right? But they qualify in Missouri. Yeah. You know, you're not going to know that they do. Okay. So, you know, that's important to understand. So they're going to know where there are differences in these plans and what kind of coverage you can get as a result of those differences.

00;26;39;11 - 00;26;42;17

Cary Hall

So it's if they just call you and have a conversation, Carolee.

00;26;42;17 - 00;27;18;17

Carolee Steele

And that way we can go through their individual scenario. What do they have? But there's so many people. The biggest thing I want to irritate is the dual special needs. That's the one where they don't think that they need anything else because basically Medicare and Medicaid pay for everything. But they're leaving so many benefits on the table, which they absolutely need that dental that vision you know, the healthy grocery the over the counter products which is your Tylenol floss, NyQuil, compression socks, all those things that are really seniors need that is available to them at no cost.

00;27;18;19 - 00;27;34;29

Cary Hall

You know and I mean think about that. If you're in a you know, if if, if and there are a lot of people out there not in the urban communities and the rural communities who are living on Social Security or maybe Social Security, a little bit of something else, they had maybe a retirement plan that they had at work or whatever the case may be.

00;27;34;29 - 00;27;42;13

Cary Hall

But but they're just barely getting by. If they got $230 a month to go spend to the grocery store, you think they'd make a difference, Carol?

00;27;42;20 - 00;27;43;25

Carolee Steele

And utilities absolutely.

00;27;43;25 - 00;28;05;17

Cary Hall

Make a hell of a difference, wouldn't it? Okay. But you're not going to know about that if you don't get on the phone and give these people call. 877 385 2224. The website RPS Benefits by Design Inc dot com and by the way, Jimmie Walker is not going to be the guy you want to call from good times to ask about this because he doesn't even know it exists.

00;28;05;20 - 00;28;30;06

Cary Hall

So I just want to make that point. Okay. You know, you see these ads out there trolling for this kind of stuff and you're not going to get this kind of service. You heard Maria talk about this. Another thing, this stuff is complicated. And so, you know, yes, you're right there with a provider issue or maybe you're up in Cameron or, you know, maybe you're in southwest Arkansas and you've got to see a specialist who's going to help you find that specialist.

00;28;30;11 - 00;28;49;01

Cary Hall

You're going to call up Jimmie Walker and ask him to help you out or your name is probably not, or maybe William Devane. Okay. I don't know, but probably not. You know what I mean? So this is a full support system. That's what these people do. They're there every day to help you. If you have a question or a problem and they do it.

00;28;49;04 - 00;28;56;12

Carolee Steele

And this is actually the time of the year that we go through an extensive amount of training and education to be able to pass, the AHIP.

00;28;56;14 - 00;28;59;19

Cary Hall

Okay. So that's interesting. So, Joyce, talk a little bit about that.

00;28;59;21 - 00;29;00;13

Joyce Thompson

So how much.

00;29;00;13 - 00;29;04;16

Cary Hall

Fun? I remember it. I was how much fun you used to do this.

00;29;04;16 - 00;29;33;14

Joyce Thompson

Talk about every once a year we have to recertify with CMS, Medicare, also with every carrier. Then once we have done that, then we can go see the rollout and see the plans, figure out which plan are we going to be showing most. And then we spend 40 hours at least 40 hours of training, testing, and then we have to pass the CMS test with the 90%.

00;29;33;14 - 00;29;53;16

Cary Hall

Do you hear that in high school? Okay, you got to pass with a 90%. And if you don't, you're not likely not sell this product. So is that a good thing? I think it is because it it gets rid of people who really don't know what they're doing and or really don't have any business doing this. You get rid of a lot of people that really shouldn't be doing this.

00;29;53;23 - 00;30;20;24

Cary Hall

But I remember we used to do this when, you know, when I when I had benefits by design before we merge the two companies and I'll tell you something, it was a process. Everybody in our office did this and it was very, very difficult. Well, the point is they go through this training every year so they know the latest changes, what's happening with the carriers, what's happening, it seems, you know, and you have to go back and you have to get certified by each carrier, because each carrier, Carolee has a different set of products.

00;30;20;24 - 00;30;22;17

Cary Hall

Correct. That work differently. Right.

00;30;22;17 - 00;30;24;24

Carolee Steele

And you have to be certified with every carrier.

00;30;24;27 - 00;30;41;26

Cary Hall

Right. So it's just not one and done. You got to if you're going to be Humana, United, Blue Cross, Cigna, you've got to get certified with four of them. Plus the story said you better get 90% or you're not gonna pass the test. So that's why they're experts, okay? They spend a lot of time doing this. They know what they're doing and they know how to do it and do it well.

00;30;42;04 - 00;30;51;16

Cary Hall

Stay tuned. We'll be right back after the break. You're listening to America's Healthcare Advocate broadcasting here on the HIA radio network, Coast to Coast across the USA.

00;30;53;00 - 00;31;04;16

Cary Hall

Welcome back. You're listening to America's Healthcare Advocate show broadcasting coast to coast across the USA. My producer, Mr. Sean Boyd. And by the way, behind the camera is Dave Thiessen, who's always behind these cameras.

00;31;04;16 - 00;31;19;26

Cary Hall

So all these shows that you see up on the video platforms, that's all done by Dave, he handles all of it. He posts them all and he transcribes them all. So that when you're out there looking for something, you can find it. It'll be on one of our podcasts, it'll be on our YouTube, whatever the case may be.

00;31;19;26 - 00;31;42;00

Cary Hall

So we're here in studio today with Carol Steele, Maria Allen and Joyce Thompson from RPS Benefits by Design, we are talking about everything Medicare up to this point. And again, the whole idea behind this is to educate and inform. And I I'm going to reiterate again, when you call these people, they're there to help you. They're not there for a high pressure sales.

00;31;42;02 - 00;31;59;24

Cary Hall

There are people to call them. They don't they have they don't they don't sell them anything. They tell them, hey, you know what? You got a great plan. Everything looks good. Leave it alone. All right? And on the other hand, if you've got something, it's not working the way it should. Or there's a better opportunity for that Part D prescription drug that's going to save you money.

00;31;59;29 - 00;32;18;21

Cary Hall

They're going to tell you that. Okay. Or if they're going to, they're going to tell you, you know what, that particular doctor or hospital that you need is probably not in that network. Let's look at something that is those are the kinds of things you are going to get by getting a hold of one of these people on the television or wherever you're seeing these ads pop up on YouTube or whatever the case may be.

00;32;18;24 - 00;32;52;10

Cary Hall

This is a whole different ballgame right here anywhere in the country. Doesn’t matter. 877-385-2224. RPS Benefits by Design Inc dot com. All right. So we've got this little situation where a lot of people are going to lose 15 million to be exact, are going to lose their Medicaid coverage starting now. Okay. And what about 5 million of those people are going to be eligible to do ACA with basically a full subsidy.

00;32;52;12 - 00;32;53;27

Cary Hall

So talk a little bit about that, Maria.

00;32;53;27 - 00;33;28;29

Maria Ahlers

Yeah, if so, when they do lose their Medicaid, they qualify for an ACA plan where they can meet with us to discuss. Again, we go over their prescription, their medical history to make sure that we counsel them on the right plans to pick out. And then we also help them get subsidy for the plan. And oftentimes the subsidy is so great that you're paying zero for the premium for the plan.

00;33;29;01 - 00;33;33;07

Maria Ahlers

So it's just a great program that people just forget about.

00;33;33;09 - 00;33;43;10

Cary Hall

Well, I don't think a lot of people know about it Maria, I mean, the problem is, you know, these people are going to be getting these letters. They're getting this letter saying you're losing your plan and they panic because they have nothing.

00;33;43;13 - 00;33;51;05

Maria Ahlers

That's right. Yeah. They don't know what to do. They say, now what? And that's what we're here for, is we're here to help them with that gap.

00;33;51;08 - 00;34;02;15

Cary Hall

And here's the other thing. It's important to understand. You're on a Medicaid plan now, right? Well, the networks and the doctors and hospitals that take Medicaid are pretty narrow, right Carolee?

00;34;02;18 - 00;34;03;03

Carolee Steele

Narrow. Yeah.

00;34;03;03 - 00;34;14;13

Cary Hall

Yeah. But if you go on one of these ACA plans, you got a full blown PPO plan. Okay, So you actually have a chance here Carolee, to improve your benefits by moving to one of these over from a Medicaid plan.

00;34;14;13 - 00;34;29;20

Carolee Steele

Yes, correct. And it kind of really depends on their kind of their gross income. We kind of calculate that to what the subsidy is. And then the subsidy can take care of quite a bit of the premium and sometimes lower deductibles and co-pays as well.

00;34;29;20 - 00;34;31;26

Cary Hall

Okay. So explain that.

00;34;31;29 - 00;34;56;15

Carolee Steele

It depends on that's income driven and household driven. So like you, if you're a household of three, it's going to depend on income. If you're below a certain threshold, then you would get a premium tax credit, which is money that the government would give to the carrier on their behalf for part of the premium. So it may be originally $900, it may go down to two or lower.

00;34;56;18 - 00;35;07;14

Carolee Steele

And then if you are in the lower part of that threshold, you would also get a cost sharing reduction which reduces the deductible co-pays and the out-of-pocket, which is huge.

00;35;07;22 - 00;35;26;05

Cary Hall

Does this sound kind of like Medicare? Sound confusing? That's because it is. All right. And you just hear you're hearing these people, they unwind this stuff. They can explain this to you. You know, you're living in a rural community. You're on Medicaid, which is where the largest number of one of one of the areas where we have the largest concentration of people on Medicare.

00;35;26;05 - 00;35;43;27

Cary Hall

We talked about this in the last segment. The folks on Medicare. This is a way you may very well, like I said, there's 5 million of you out there across the country that will qualify for one of these ACA plans with the very low premium or no premium. Okay. And that's important to say. And do yourself a favor.

00;35;43;27 - 00;36;01;08

Cary Hall

Okay? Don't call the one 800 Bible number. Okay? I know you hear these commercials, okay. But I'm just going to you know, I want to make this clear to you. You know, there are a lot of people on those plans. So that's called Christian Medi-share. And I'm not going to knock the plan. But what I'm going to tell you is it's not health insurance.

00;36;01;15 - 00;36;21;28

Cary Hall

And if you get when you go on the website or you look at the paperwork, it says clearly this is not health insurance, okay? Because it's not. And why is that important? Because it's not regulated by the state insurance commission or the federal government in that respect. So if you have a claims issue, there's no appeal to the Department of Insurance or the carrier.

00;36;21;28 - 00;36;40;19

Cary Hall

You're dealing with these people that run this particular program. So I I'm not a fan of this. I know a lot of people sign up for it. It works for a lot of people. And I also know a lot of stories about a lot of people who it hasn't worked for. Okay. So what I'm saying is, if you're in that situation, you're on Medicaid, you're hearing that commercial, I think, well, I go call them.

00;36;40;22 - 00;36;52;15

Cary Hall

You go ahead and do that. But I would strongly suggest that you give these folks a call and see if you qualify for a fully subsidized or 90% subsidy ACA plan. That's going to make a big difference, right?

00;36;52;18 - 00;37;01;22

Carolee Steele

Absolutely. And then also there, the loss of Medicaid aid is an immediate special enrollment. So you can enroll outside of the open enrollment in the fall.

00;37;01;22 - 00;37;05;16

Cary Hall

See, I didn't even know that. So now you have a special enrollment period where you can enroll, Maria.

00;37;05;18 - 00;37;24;16

Maria Ahlers

Well, and Cary, what about the population that is wanting to retire early but doesn't qualify for Medicare? What do they do? They qualify for the ACA plan as well. And they can meet with with us to go over to help them until they get onto Medicare.

00;37;24;24 - 00;37;48;00

Cary Hall

Okay. That's important because there's a gap there. So you're 63, maybe you're your husband's 65 and he's retiring, but you're you're the spouse, you're the wife, and you're 63. What are you going to do for two years? He's losing the employer sponsored health care. Now. What are you going to do? So what you're saying is, A, they can qualify for one of those plans and get on one of those plans or there are short term plans they can do as well, right?

00;37;48;00 - 00;37;48;15

Cary Hall

That's right.

00;37;48;18 - 00;37;49;10

Maria Ahlers

That's right.

00;37;49;13 - 00;37;51;11

Cary Hall

So talk to them about those Joyce.

00;37;51;11 - 00;38;14;19

Joyce Thompson

The short term policies. There's two companies here that have them. One is Blue Cross of Kansas City and the other one is UnitedHealthcare. And then there may be some others out there, but they're good plans to fill in the gap between Medicare and 63 or 62. I have several clients that they do that they're healthy and they can get the short term policy.

00;38;14;19 - 00;38;25;25

Joyce Thompson

The premiums are low, the benefits are pretty good, especially Blue Cross. They you can use the blue card and go anywhere in the country with it. So they're good plans.

00;38;25;25 - 00;38;40;04

Cary Hall

And they are PPO plans. Okay. So that's important to know. Now, you heard Joy say her people are healthy, they are medically underwritten. So if you've got you know, if you've got a heart condition or cancer, you're not going to qualify. That's when you have to go to an ACA plan. That's right.

00;38;40;10 - 00;38;40;24

Maria Ahlers

That's right.

00;38;40;24 - 00;38;53;22

Cary Hall

So, again, you're not going to know this stuff. You probably don't even know that there is the, you know, a short term plan out to that may cost you $200 or $300 a month. It can make all the difference in the world. You have full blown coverage. That's important.

00;38;54;02 - 00;38;57;04

Cary Hall

Thank you all for doing this great show today. A lot of information.

00;38;57;10 - 00;39;01;15

Cary Hall

Yeah, it was like drinking from a fire hose if you're listening. But that's that's how you learn.

00;39;01;21 - 00;39;02;06

Carolee Steele

Thank you.

00;39;02;08 - 00;39;22;01

Cary Hall

Ladies. RPS Benefits by Design. Give them a call if you need help. 877-385-2224 anywhere in the country. And now I leave you with this thought from Dr. Martin Luther King. Americans must learn to live together as brothers and sisters or we will surely perish together as fools. Truer words were ever spoken, especially today.

00;39;22;09 - 00;39;29;16

Cary Hall

Thank you for listening to America's Healthcare Advocate show Broadcasting coast to coast across the USA. Goodbye, America.