Episode 1908 Transcript

Announcer

And now America's Healthcare Advocate, Cary Hall.



00;00;05;00 - 00;00;21;26

Cary HAll

Hello, America. Welcome to America's Healthcare Advocate Show, broadcasting coast to coast across the USA, from Alaska to Florida all the way to Hawaii. Our producer today, Mr. Darin Willhite. I'm your host, Cary Hall. This is your show, America. Thank you for joining us for making us one of the most listened to talk shows throughout the United States.

0;00;22;05 - 00;00;41;06

Cary HAll

We appreciate all of you out there. If you want to follow us, you can do that at America's Healthcare Advocate on Facebook and Instagram and as I always tell you, all these shows are posted on the podcast platforms and on YouTube. And we're getting so many podcast platforms, so probably have to stop reading these, but I'm going to go through it today.

0;00;41;15 - 00;01;13;07

Cary HAll

We're on. Pocketcasts. Speaker Spotify, Google Podcasts, RSS Feed Podcast. Tune in Amazon Music. I don't know how we got on there. Pandora podcasts, Overcast, Stitcher, listen on SoundCloud and Apple Podcasts. So we're on 12 podcast platforms now. We got a lot of people listening to this on podcast platform. Today's show is going to be on two topics, and these are topics that you may want to tell somebody about and go up on that podcast platform to listen to.

0;01;13;14 - 00;01;39;07

Cary HAll

We're going to talk about Medicare special needs. This is a special product line that is available from certain carriers that RPS Benefits by Design services. We're going to talk about that and who qualifies and why. And this is important. This is information you're going to want to know. And the second thing we're going to talk about is we're going to talk about Medicaid and what's going to happen to the 15 million people that are going to lose their Medicaid coverage.

0;01;39;21 - 00;02;00;16

Cary HAll

That's what I just said, lose their Medicaid coverage in in April of this year because the omnibus spending bill had a provision to cut these people off of Medicaid. Now, here's the thing. 6.1 million of those people will qualify for an ACA policy at about $10 a month. We're going to talk about that and how you can do that.

0;02;00;16 - 00;02;19;14

Cary HAll

So this is an important show and it's a show that you're going to want to make sure if you have somebody in that circumstance, you can tell them to go back up to the podcast platform and listen. All right. If you are looking for help with any of these things, I have in studio today with me Maria Ahlers, Carolee Steele, and the lovely Joyce Thompson here today. And we're going to talk about all this stuff. They're available to you at RPS Benefits by Design. You can call them anywhere in the country at 877 385 2224. They are happy to help you Will. You'll listen to them talk about how they do this today and how it all works. So those are our topics and that's where we're going to start.

0;02;42;10 - 00;02;59;09

Cary HAll

So let's just kind of start off with Carolee. Let's just start off with this whole special needs. The three areas where people can qualify for special needs. So you've got chronic condition, chronic conditions. Okay. So that's typically somebody that has diabetes or heart condition.

0;02;59;17 - 00;03;01;05

Carolee Steele

Or several of them combined.

0;03;01;06 - 00;03;12;20

Cary HAll

Correct. And that so you may qualify for one of these plans under that condition. If you are in a nursing home or if you have an equivalent of that kind of home health care.

00;03;12;20 - 00;03;15;18

Carolee Steele

Correct. Institutional, which is actually for Medicare.

00;03;15;28 - 00;03;34;17

Cary HAll

Okay. And then if you're on Medicaid, okay, if you're on Medicaid, you can qualify for one of these Medicare Advantage plans. That's a special needs plan. So we're going to talk about how you do that. What what all of that is say. That's the first topic we're going to cover today. They're going to chat a little bit about we're going to go into this ACA Medicaid thing.

00;03;34;26 - 00;04;04;01

Cary HAll

But Maria, let's talk a little bit. You know, there's a plethora of ads out there. I watch a lot of YouTube. I watch YouTube when I when I'm in the gym, I like to watch the the the the music shows and some of that stuff, you know, The Voice and America's Got Talent and stuff that I watch. And every like eight or 9 minutes, there's an ad on there now for people to what they're doing for telling you, hey, would you like $600 for groceries?

00;04;04;06 - 00;04;28;07

Cary HAll

What that is, is that's a come on for the Medicare special needs products. The problem is you're calling some national call center where they don't know you know, anything about the part of the country you're in or what you're doing or anything else. What happens to those people if they sign up for that and then they call back three months later because they've got a condition or they've got a claims problem or provider problem they need help with? Maria Well, most of the time you're not going to get much help from them because it is a national number. Whereas if you use RPS Benefits by Design, we have we really pride our self on that personal service of being able to help you with the claims. We have a strong relationships with our carriers so we can make those calls.

Advocate on your behalf. You can call a the number that you mentioned Cary, 877 385 2224 and you'll get a live person.

Cary HAll

Yeah, there you go. A lot. You know, not 14 voice prompts people, but a live person that's almost unique in today's world.

Maria Ahlers

Absolutely. It is unique. I mean, how many times have we called anyone in your pushing this number or say yes or say no, but with RPS you'll get a live person. And not only will you have one person able to service you, but we have a team of experience, account managers that service you are expect our experience on our team has carrier background, HR background. And then as you mentioned, medicare, medicaid background where we are able to provide creative solutions for our our clients.

Cary HAll

You know, and it's funny too, because, you know, if you're if you're an employer, you know, you're a large employer or whatever the case may be, you typically get that kind of service. But we're talking about somebody buying an individual Medicare special needs product, Carolee, or somebody who loses his Medicaid, which we'll talk about later in the show for them to get actual care, for them to be able, as you just talked about, Maria, to be able to have somebody actually talk them, help them.

That's pretty unusual.

Maria Ahlers

Absolutely. Benefits is not a fun topic that most people enjoy talking about, and it's overwhelming. So we walk you through the details. We understand your medical history and find a plan that is customized to you, that works for you and your family. When you call these national hotlines, they're not taking the time to really dive deep into what your needs are. And that's where we really specializes understanding your needs and what you need and the plan that fits for your family.

Cary HAll

Yeah, and it's not moving us. Let's get this done. To move to the next sale is get to start to move to the next sale, which is how these call centers work. So I'm spending time on this. I know you're seeing these commercials. They're on they're on CNN, they're on FOX, They're they're on MSNBC. They're all over the place.  Okay. It's just like during open enrollment when you see those commercials with Joe Namath and the former governor of Arkansas, it's remarkable to me. All the people that get to do these things. But having said all of that, it's the same thing. It's just a different product to talking about now. But you're dealing with the same people. And I caution you in doing that because if they get it wrong or if you need help after the fact, you're not going to have much luck in getting that help. So let's go back in, Carolee, to to those three categories. So chronic conditions. So if you're on a medicare policy, Medicare Advantage policy, because these are all Medicare Advantage, yes, they are. Okay. That in a chronic condition, you don't need to wait for open enrollment to do this, do you?

Carolee Steele

Correct. You can enroll the first three quarters of the year. You have an open enrollment season that you can go ahead and change plans should you need to during that time, which is different than the regular population.

Cary HAll

Right. So you so, you know, if somebody has a heart condition, it's you know, if they've got you know, if they've got diabetes, if they've got type one diabetes, you know, and there are other conditions as well. And so talk a little.

Carolee Steele

Bit about well, there's so many additional benefits to the the special needs plans that are not available for the average Medicare Advantage plan. And so it services them, For instance, even on the dual eligible plans for people on Medicaid, Medicare has so many moving parts just by itself. And then you add on another level like Medicaid or chronic, and then you have a whole nother at issue with as far as benefits, there's whole different levels of benefits that are available to these populations.

00;08;33;19 - 00;08;49;27

Cary HAll

And we're going to get into the benefits. We'll do that in the next couple of segments. But, you know, I want to concentrate now on just telling people out there. We just covered two issues. If you're on let's say you're out in a rural community, there are a lot of people on Medicaid in the rural communities, probably more than there are in the urban communities on a percentage basis.

00;08;49;27 - 00;08;57;16

Cary HAll

If you're on a medicaid plan and you don't have one of these Medicare Advantage special needs programs, they should take advantage.

00;08;57;18 - 00;08;59;10

Carolee Steele

Absolutely. Absolutely.

00;08;59;21 - 00;09;19;24

Cary HAll

And when we get into the benefits on this, you're going to be probably a little surprised and probably a little shocked at the difference in these benefits and the typical Medicare Advantage plans. So so those are two categories. Medicaid, chronic condition. Now, let's switch gears and talk about somebody that's in a nursing home and how this works for them.

00;09;20;10 - 00;09;37;12

Carolee Steele

And not all carriers have that, but the ones that do, they actually target those those three things, chronic and then also in their institution. That's what it's called. And they've got special benefits specifically designed for that particular population.

00;09;37;18 - 00;09;56;06

Cary HAll

And that also applies if you have that level of home health care. If you're doing home health care, somebody is doing on health care, you're a caregiver, whatever the case may be, those plans are available to you as well. If they demonstrate that same level. We come back from the break now. We're going to start getting into these plans a little bit and start explaining some of these benefits.

00;09;56;06 - 00;10;19;07

Cary HAll

I think you're going to be surprised by what you're going to learn. Stay tuned. We'll be right back after the break. If you want information, call Carolee. Call Joyce, Call Maria. 877-385-2224. You're listening to America's Healthcare Advocate broadcasting here on the HIA Radio Network. Coast to coast, across U.S.A.

00;10;19;08 - 00;10;20;03

Cary HAll

Don't go anywhere.

00;10;21;17 - 00;10;41;15

Music

That won't be long. People out to the will be. One day I'll be down and my right.

00;10;42;17 - 00;11;14;20

Cary HAll

Welcome back. You're listening to America's Healthcare Advocate Show, broadcasting coast to coast across the USA. We're here to serve. And that's what we're doing today. We're talking about Medicare, Special Needs. Who qualifies for these? And when I tell you, when we Carolee and I get into the benefits here, we start talking about this. You're going to get a real clear understanding of why, if you're a care giver, if you've got a relative in this situation, or maybe you're a home health care professional, that you've got clients paying out of their pocket and they can only get to you, Maybe you can only go see them once a week or twice a week because

00;11;14;20 - 00;11;34;24

Cary HAll

that's all they can afford. If they're on one of these plans, that all changes. So we're going to talk about that in this segment. If you want information on that, you can call RPS Benefits by Design. You can talk to Maria or you can talk to Joyce Thompson or you can talk to Carolee Steele and the number is 877 385 2224.

00;11;35;01 - 00;11;56;29

Cary HAll

They are there to help you if you maybe you don't know. I don't know. Maybe maybe mom's going to qualify for this or maybe my grandmother is going to qualify or maybe your uncle that'll qualify. Well, pick up the phone and call them there. You heard Maria say this in the first segment. They'll walk you through the process.

00;11;57;05 - 00;12;21;01

Cary HAll

They will stay with you. They'll get you qualified, you her heard Carolee say how confusing this stuff can be. It's very confusing. Okay. But these folks are experts there CMS Certified, Trained, Licensed Agents that understand this stuff and understand how to do it. So, Carolee, with that, let's kind of get into the differences between let's contrast this with typical Medicare Advantage plan.

00;12;21;01 - 00;12;24;10

Cary HAll

So a lot of Medicare Advantage plans have zero premiums.

00;12;24;11 - 00;12;24;23

Carolee Steele

Correct.

00;12;24;29 - 00;12;27;17

Cary HAll

But after zero premiums, what happens?

00;12;27;18 - 00;12;55;06

Carolee Steele

There's co-pays and co-insurance. And so and then out-of-pocket maximums on the Special Needs plans, it's zero. And then most of the co-pays and co-insurance are zero as well. As long as they qualify for Medicaid, they have full Medicaid and then they have Medicare. Some people say, well, I've got Medicare and Medicaid pays what it doesn't, but they have no idea what type of benefits that they are missing out on with these special needs.

00;12;55;06 - 00;13;21;04

Cary HAll

And they're leaving it on the table. And that's what we're trying to make you out there. If you're on Medicaid, that's one of the that's one of the three segment. If you're on Medicaid, if you've got a chronic medical condition like diabetes or heart stroke, whatever the case may be, or if you're institutionalized, if you're in a nursing home or you have equivalent home care, meaning you've got to have somebody come in and help you bathe, somebody dress you, somebody take care of your needs at home.

00;13;21;10 - 00;13;35;11

Cary HAll

Well, then you you may well qualify for one of these. So the again, how do you find that out? You call these folks and they are happy to help you. But we're going to go through now because I want to illustrate this to you. So the monthly the monthly plan premium is what?

00;13;35;12 - 00;13;35;26

Carolee Steele

Zero?

00;13;35;27 - 00;13;44;19

Cary HAll

Thank you. Annual Medicare deductibles, zero primary care, zero special zero specialists visit.

00;13;44;27 - 00;13;45;10

Carolee Steele

Zero.

00;13;45;11 - 00;13;46;05

Cary HAll

Referrals.

00;13;46;20 - 00;13;47;06

Carolee Steele

None.

00;13;47;13 - 00;13;51;04

Cary HAll

Right. In inpatient hospital care, None. Now, here's.

00;13;51;05 - 00;13;52;07

Carolee Steele

That zero co-pay.

00;13;52;07 - 00;13;59;22

Cary HAll

Correct. Now, contrast that with the Medicare plan, because on a medicare plan, Medicare Advantage, you're paying $250, $300 a day for what, the.

00;13;59;26 - 00;14;02;22

Carolee Steele

Days one through five and then six or 90 is zero, Correct.

00;14;02;29 - 00;14;06;01

Cary HAll

Here it's zero. Okay. Outpatient surgery.

00;14;06;07 - 00;14;06;26

Carolee Steele

Zero.

00;14;06;27 - 00;14;12;27

Cary HAll

And again, on a typical Medicare Advantage plan, that's going to be 350, $500, something like that.

00;14;12;27 - 00;14;14;26

Carolee Steele

Correct. That goes to your out of pocket. Correct.

00;14;15;00 - 00;14;19;28

Cary HAll

Okay. And obviously, there's an out of pocket of which there is not here. Home health care.

00;14;19;29 - 00;14;20;15

Carolee Steele

Zero.

00;14;20;16 - 00;14;36;24

Cary HAll

And that's a big one. So that's the one where I'm talking to you folks out there that, you know, maybe your mother. Yeah, I've got a very good friend with this. She is almost 90 years old. She absolutely, irrevocably is not going to leave her house. So they've got home health care for her. She's on one of these plans.

00;14;36;24 - 00;14;53;02

Cary HAll

It makes all the difference in the world because they've got somebody able to come in and help her with her needs. You know, if you're if you're that caregiver and you have to go take care of all those things yourself every day that's going to wear you down, it's going to wear you out. It's a it's a it's a huge burden for people.

00;14;53;10 - 00;15;00;27

Cary HAll

Kate. This is a way where you can have this plan, have competent help, and make sure that your loved ones are being well taken care of, right?

00;15;01;07 - 00;15;02;01

Carolee Steele

Absolutely.

00;15;02;03 - 00;15;06;06

Cary HAll

Yeah. And that's one of the that's one of the really good things about this plan. Lab services.

00;15;06;26 - 00;15;07;14

Carolee Steele

Zero.

00;15;07;14 - 00;15;08;28

Cary HAll

An emergency care.

00;15;08;28 - 00;15;09;27

Carolee Steele

Zero co-pay.

00;15;09;28 - 00;15;20;27

Cary HAll

And that's another one that's a big deal. So if you wind up going to an E.R., you're not paying a dime, you know, And that happens to folks that you've got a chronic condition. You may wind up in the air.

00;15;21;09 - 00;15;21;29

Carolee Steele

Absolutely.

00;15;22;16 - 00;15;37;06

Cary HAll

You know, those are the kinds of things that happen where you may you may have to go into an E.R. because something happens to you at 2:00 in the morning and you're not going to go see a doctor, not you. Here you have access to the emergency room and urgent care.

00;15;37;20 - 00;15;38;19

Carolee Steele

Zero co-pay.

00;15;38;21 - 00;15;39;20

Cary HAll

That's a lot of zeros.

00;15;39;21 - 00;15;40;20

Carolee Steele

Lots of zeros.

00;15;41;25 - 00;15;52;08

Cary HAll

And the point, again, that we're trying to illustrate, there is that this on a regular Medicare Advantage plan, Carolee, their typical they're paying co-pays on every one of those.

00;15;52;22 - 00;16;16;04

Carolee Steele

Co-Pays and co-insurance until they hit an out-of-pocket maximum. I will piggyback on that. I will say that as far as the brand name generic meds, that tends to be sometimes, especially with people who are ill, that tends to the biggest hurdle is getting their medications covered and covered well and at a lower cost share than originally that The cases.

00;16;16;04 - 00;16;20;09

Cary HAll

That you brought that up, let's do it. Talk about the cost of prescription drugs on here.

00;16;20;15 - 00;16;28;02

Carolee Steele

Yeah. And and branded generics are going to be zero and and that is the biggest expense I think for a lot of the seniors is their medications.

00;16;28;13 - 00;16;29;08

Cary HAll

You're shaking your head.

00;16;29;08 - 00;16;36;19

Maria Ahlers

Yes, absolutely. I mean, that's a big cost for a lot of people, not just for the seniors, but yeah.

00;16;37;03 - 00;17;00;11

Cary HAll

so right there out of the gate, we just took basically every medical expense you could have and told you it's going to cost zero. And Ed, you heard Carolee say in the opening part of the segment, you're leaving these benefits on the table. Oh, I've got Medicaid, but I have I have Medicare. Well, you know, you may have Medicare, but you don't have this, okay?

00;17;00;15 - 00;17;09;18

Cary HAll

And you don't have access to these services and you don't have the ability to walk into any hospital or any doctor that takes Medicare anywhere in the country. And you're covered.

00;17;09;28 - 00;17;30;20

Carolee Steele

Mm hmm. Yep. You definitely are. And I would say, too, especially with the medications being so low, I know I come back to that. But like I said, that tends to be some of the seniors biggest worries. When you are on a specialty plan, you also do not have to go through the coverage gap. There is no donut hole there.

00;17;30;20 - 00;17;32;24

Carolee Steele

You do not have to pay. You don't have to do the donut hole.

00;17;32;24 - 00;17;34;24

Cary HAll

So yeah, yeah, explain it.

00;17;34;24 - 00;18;16;06

Carolee Steele

660 typically with with Medicare and you go through it whether you have a standalone prescription drug plan or it's built into or embedded into a medicare Advantage plan, everyone is subject to the coverage gap and that is what is the retail medicine that the carrier and the individual pays for when it reaches like right now it's $4660. And then they would go into the coverage gap, which then you would go to 25%. You have to pay 25% on all of your medications until you hit that 7400. And then it goes to a catastrophic phase. So with this population who probably needs it the most, they are not subject to that coverage gap.

00;18;16;11 - 00;18;35;27

Cary HAll

C so what we're the as we're going to these benefits, I want to make sure I make clear we're giving you this offer, the United Health plan, this United Health Care’s plan. And this this is their model that we're reading these benefits that it may vary with the different carrier, but but we have to illustrate, just so you understand, this is the United Health care model.

00;18;35;27 - 00;18;57;25

Cary HAll

United is a national company. They're they're partnered with AARP, so everybody knows who they are. Okay. But we're using this as our template, as our model. And UnitedHealthcare is a product that RPS Benefits by Design services and is able to assist people at obtaining for these particular issues. And they vary on state by state.

00;18;57;25 - 00;19;02;04

Carolee Steele

Yes, correct. Absolutely. Because Medicare Medicaid varies state by state as well.

00;19;02;12 - 00;19;25;25

Cary HAll

Yeah. And that's important to understand. So, you know, if you're that Medicaid person, you need to understand that may be somewhat different where you are. But again, as I said earlier, you know, they can help you anywhere in the country if you want to call them 877-385-2224. When we come back, we're going to get into the other part of these benefits, the part that's probably going to surprise you the most.

00;19;26;02 - 00;19;48;10

Cary HAll

Stay tuned. You're listening to America's Healthcare Advocate broadcasting here on the HIA Radio Network. Coast to coast across the U.S.A., we've got more.

00;19;48;10 - 00;20;02;11

Cary HAll

Welcome back. You're listening to America's Healthcare Advocate broadcasting coast to coast across the USA. We are on 12 podcast platforms. I'm not going to read them all again, but I'm telling you, if there's a podcast platform out there, we're not all that like or what it is.

00;20;02;17 - 00;20;24;19

Cary HAll

You can find this show on the podcast platform. If you if you've got somebody in your family, you've got a friend, you've got somebody go to church with, you know, whatever the case may be, if you know someone that's in need that qualifies for one of these three special needs categories, this is a program they need to be able to listen to, and you need to tell them to go to America's Healthcare Advocate on the podcast platform.

00;20;24;19 - 00;20;50;03

Cary HAll

Whatever your favorite platform is, we're up there. Okay. And you can listen to the show. My producer, Mr. Darren Wilhite. I'm your host, Kari Hall. In studio with me, Maria Ahlers Client Services RPS Benefits by Design. Carolee Steel and Joyce Thompson, both Medicare specialists and ACA specialists. And we're still talking about Medicare special needs. So you just we just were talking about this off air, Maria, Let's talk about this again.

00;20;50;24 - 00;20;53;14

Cary HAll

Somebody is they're intimidated by this.

00;20;53;17 - 00;21;20;03

Maria Ahlers

They are. Yeah, they are. Benefits is not fun for people. I mean, it's it's very detailed and it's intimidating and people are afraid to talk about it, but everyone needs it. So whether you whatever your situation is, call us. We have experts to determine what those best and plans are. You can bring in your scenario and say, if this happened, how much would I pay if I get this prescription?

00;21;20;03 - 00;21;27;27

Maria Ahlers

How much would I pay? And that way you know exactly what your costs will be. And according to the plan here, the number is zero.

00;21;28;14 - 00;21;45;23

Cary HAll

Yep. And again, they're with you for the journey. They're not with you to sell you like the National Call Center and then you don't know who the hell you're talking to. This is a totally different deal. You have the same people to go back to each and every time. You told me an interesting story before the before the broadcast about a man who called you up.

00;21;46;03 - 00;22;11;21

Carolee Steele

He called me up and there was a pre-authorization for the surgery he was going to have on the following Tuesday. And so I went ahead and on his behalf, kind of advocated for him with the carrier. And at the very end, we finally got him approved at like 4:30 p.m. and he was like, Oh, my gosh, Carolee, I'm so glad you're my broker and I'm so glad I have this carrier to be able to get it.

00;22;11;21 - 00;22;13;10

Carolee Steele

And so he had surgery to do this.

00;22;13;10 - 00;22;37;18

Cary HAll

It goes back to what marriage said. You got to get a pre-cert. You know, whatever the case may be, they're there for you and they're going to help you get that done. So, again, if you if you're looking for help, 877-385-2224. I don't care where you're at in the country, they can help you. So let's go to the second half of this because this is the part that you're seeing on these TV commercials with this teaser about you can get $600 for groceries.

00;22;37;18 - 00;22;44;28

Cary HAll

So I'm we're using United Health Care model right now. So let's just go through food, utilities and over the counter per month.

00;22;45;07 - 00;22;47;20

Carolee Steele

230 a month to buy those healthy food.

00;22;48;10 - 00;22;57;23

Cary HAll

That's not available on Medicare Advantage plans. Okay. It's available on special needs programs. That's any one of those three categories. We've talked about dental benefits. And this is huge. Huge.

00;22;57;23 - 00;23;02;04

Carolee Steele

It's $4000 for covered types of preventative and comprehensive dental.

00;23;02;05 - 00;23;05;01

Cary HAll

Now, contrast that with typical Medicare Advantage plan.

00;23;05;04 - 00;23;06;16

Carolee Steele

It's about $1000.

00;23;06;18 - 00;23;21;23

Cary HAll

About a thousand, not a thousand. This is a $4,000 benefit. Okay. That's that. That means if you needed an implant, if you need a bridge, whatever your dentures, whatever the case may be, you've got $4,000 here to work with. All right, let's go to routine transportation.

00;23;22;05 - 00;23;27;23

Carolee Steele

Okay. Zero copay for 48. One way rides to and from doctor's office. And why is that important?

00;23;28;03 - 00;24;02;00

Cary HAll

So you're it's your mom or your dad, okay. And you can't leave work again today. My daughter works at Morgan Stanley. She can't walk out the door, you know, because she's got to take Lori or me to the hospital if something were to happen to us, you know, or to a doctor is a typical doctor's appointment. Okay. But if you have this benefit, you've got somebody that this is not you're not calling the cab company or you're not calling Uber, you're calling somebody that specializes in medical transportation, that if you're in a wheelchair or you're immobilized or you're an amputee, they'll put you in a van.

00;24;02;01 - 00;24;05;18

Cary HAll

They'll take you, they'll bring you back. They're there to get they accommodate.

00;24;05;18 - 00;24;05;27

Carolee Steele

Yes.

00;24;06;04 - 00;24;21;21

Cary HAll

And yet 48 of those rides. Okay. That can make a big difference. Maybe it means you just go meet your loved one at the doctor's office or the specialty center or whatever the case may be, but it's a benefit that you would have. Let's go down to routine vision benefits.

00;24;21;21 - 00;24;29;24

Carolee Steele

Okay. That's a zero co-pay on your yearly routine exam. And then you have a $600 allowance for frames and lenses. Yeah.

00;24;29;24 - 00;24;40;12

Cary HAll

And that's another one that's very different than a typical Medicare Advantage plan where you've got maybe two, $300 typically. Yeah, you've got $600 and then routine hearing. This is another one that's huge.

00;24;40;16 - 00;24;45;06

Carolee Steele

3600 allowance for the broad selection of brand name hearing aids.

00;24;45;07 - 00;25;10;11

Cary HAll

Okay. So, you know, as we age, those of us that are chronologically challenged like me at 73 years of age, you start to you're hearing starts to go down. I wear a hearing aid. Boom, I've got it on right now. Okay. You can't see it, but I'm wearing it. They're expensive. This thing was $2500. If I was on this plan, I would've paid nothing because I've got a $3600 allowance.

00;25;10;18 - 00;25;17;22

Cary HAll

So again, you've got a, you know, a loved one. They need hearing aids. They don't have the money. You've got $3600 here.

00;25;17;29 - 00;25;32;17

Carolee Steele

And I think it really is for as far as hearing, too, it affects this. There are social connections with people and really makes a difference that which which then also affects their mental health. And so that really kind of just is a piggybacks onto this that.

00;25;32;19 - 00;25;37;02

Maria Ahlers

Carry with a hearing aid you can't use excuse with Laurie that you can't hear her.

00;25;37;06 - 00;26;04;24

Cary HAll

It's true that yeah you're right I can't so that eliminates any way around that and no doubt about that. And then this has this has a gym membership gym partnership available on United. Now, here's something I didn't know. I was talking to Mario Walker at UnitedHealthcare on Friday. We had a meeting. We were talking about some stuff. Do you know that they send out a a home gym kit to people in rural?

00;26;04;25 - 00;26;07;15

Cary HAll

I like to fell over when I heard him in rural.

00;26;07;15 - 00;26;20;02

Carolee Steele

Community cannot get to someone to be members. Yes they send out the fitness equipment thing, not equipment, but bands and such. And then so that they can do that in rural communities. Some of that you know the gyms are far away.

00;26;20;10 - 00;26;21;20

Cary HAll

Oh, they don't have a gym or.

00;26;21;27 - 00;26;22;13

Carolee Steele

Even have one.

00;26;22;13 - 00;26;42;26

Cary HAll

Crowd. I mean, if you're in Bethany, Missouri, I don't know if you've got a gym or not. Okay. You know, if you know, if you're in some of these rural communities, they may not have that facility. If you do, they've got you'll you'll be able to go to the gym and it's all covered by UnitedHealthcare. So when you add all of those benefits up, that is a lot of dollars in here.

00;26;43;00 - 00;27;06;17

Cary HAll

You know, you're talking about $4000. You're talking about, you know, you know, you're talking you have 4600. You got another $3600. So you're looking here $7000, $8000, almost $8,000 in benefits here that are covered. And then back up here when we get back to prescription drugs, which Maria said, that's the single biggest thing in it, is it's brand name.

00;27;06;17 - 00;27;16;06

Cary HAll

It zero is generic zero, Right? I mean, do you think it makes sense for people to stop for a minute and think about maybe there's something we should look for, see if mom qualifies for her?

00;27;16;06 - 00;27;21;29

Carolee Steele

Dad qualifies. And it's one of our highest need populations that really can utilize some of these benefits.

00;27;22;29 - 00;27;45;24

Cary HAll

It's really important to understand that folks and these people are experts. They'll qualify you. You don't have to do anything but pick up the phone. 877-385-2224 They are happy to help you. Okay. As you heard Carolee say and you heard Maria say, it's complicated. Okay. How many hours do you have to go for training every year for CMS to qualify?

00;27;45;24 - 00;27;48;03

Cary HAll

Is it 21 hours now?

00;27;48;03 - 00;27;53;29

Carolee Steele

We it's and that plus we have to score 90% on our thing no matter what.

00;27;54;00 - 00;28;06;22

Cary HAll

Yeah, so I understand something. This this is difficult. This is not easy for people to do. All right. And these folks this so you have to do 21 hours of training. You have to take a test and 70% is not passing. 90 is.

00;28;06;22 - 00;28;07;14

Carolee Steele

And every year.

00;28;07;17 - 00;28;23;00

Cary HAll

And you do this every oh, and then you get to go get certified by the carrier. Correct. Which is that you're all nod your heads which is another glorious four or five or 6 hours of training to do that. You understand why they're experts and how many years you've been doing this. Don't give me your age. I just want how many years you've been doing it?

00;28;23;12 - 00;28;24;00

Carolee Steele

2010.

00;28;24;02 - 00;28;28;27

Cary HAll

Okay. Joyce, How many years you've been doing it? 15. Okay. And Maria, how many years you've been in this business?

00;28;29;06 - 00;28;30;10

Maria Ahlers

Over 25 years.

00;28;30;10 - 00;28;46;13

Cary HAll

Okay. You see, here it is. That's what I'm talking about. Okay? These people have the experience along with other staff members. RPS Benefits by Design and they can help you with this stuff and they will help you with it. All right. We're going to switch gears here. We've got a short amount of time left in segment, so I'm going to kind of set the stage.

00;28;46;20 - 00;29;15;21

Cary HAll

We come back in the fourth segment. We'll talk about this next topic. The omnibus spending bill is going to take Medicaid benefits away from 15 million people. 15 million are going to lose their Medicaid benefits on a state by state basis. About 6.2 million of those people are going to qualify for an ACA individual health insurance plan. So the biggest problem that I see and you're nodding your head, Carol, is they don't know they qualify.

00;29;15;22 - 00;29;16;07

Cary HAll

Correct.

00;29;16;28 - 00;29;35;17

Carolee Steele

And I think when they determine if they are if they do actually get then taken off of Medicaid, a lot of them qualify for a tax credit. And that's money that the government gives to the carrier on their behalf for part of that premium. And so they will qualify and they may not qualify for Medicaid, but they'll qualify for a tax credit.

00;29;35;17 - 00;29;56;11

Cary HAll

Yeah. And so and don't confuse that with like you're going to you don't get the money and you've got to pay it and you get it back on tax. That's not how it works. Okay? It's a piece that I read the other day said the average premium for somebody coming off of Medicaid, losing it and going on to an ACA plan and ACA individual may notice Obamacare, whatever you call it, is $10.

00;29;56;18 - 00;30;22;13

Cary HAll

That's the average. They're saying people are going to pay $10 a month. So when we come back from the break, I'm going to get into that and explain that and talk about how these folks that are RPS Benefits by Design can help you. 877-385-2224 if you want help. 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 the U.S..

00;30;22;21 - 00;30;25;01

Cary HAll

Stay tuned.

00;30;29;29 - 00;30;48;11

Cary HAll

Welcome back. You're listening to America's Healthcare Advocate Show broadcasting coast to coast across the fruited plain here on the HIA radio network. My producer, the always perfect Mr. Darren Wilhite. I'm your host, Cary Hall. If you want to learn more about us America's Healthcare Advocate dot com is the website. Lots of stuff up there, lots of information.

00;30;48;19 - 00;31;03;16

Cary HAll

All these shows are posted again on all the podcast platforms. There are 12 of them. I'm not going to read them all again, but you can find the show up there. If you know someone that needs help with these issues, that's where you tell them to go and listen to the broadcast or listen to it with them, whatever the case may be.

00;31;03;23 - 00;31;26;08

Cary HAll

If you want somebody to help you with either one of these issues, these special needs Medicare programs or the what we're talking about now, which is you're losing your Medicaid in April, can I qualify for an ACA policy? 877-385-2224 They are there to help you. Maria Ahlers, Carolee Steele, Joyce Thompson. And there are other people on staff as well.

00;31;26;15 - 00;31;43;07

Cary HAll

But these folks will help you directly with any issues you may have. 877-385-2224. The website is RPS Benefits by Design Inc dot com. All right. So let's talk about this because there's a tsunami coming. It's not a good one.

00;31;43;07 - 00;32;07;02

Carolee Steele

Absolutely. Absolutely. Well, as of April 1st. Well, first of all, let's back up People who lose Medicaid generally, it's their income rises and falls and so they'll get Medicaid or not. April 1st, state Medicaid agencies can conduct redeterminations for people enrolled in Medicaid. Right now, states states are not allowed to take them off of Medicaid because of that.

00;32;07;02 - 00;32;07;26

Carolee Steele

The COVID 19.

00;32;08;09 - 00;32;08;24

Cary HAll

Pandemic.

00;32;08;24 - 00;32;20;14

Carolee Steele

Yep, yep, yep. And so that will no longer be in place. So what they'll do is they'll go do a redetermination of what it was prior to the pandemic. So a lot of people are going to be losing their Medicaid coverage.

00;32;20;28 - 00;32;37;25

Cary HAll

But again, in the national surveys that have been conducted and we're done by, you know, a number of different groups, Kaiser Foundation did want a bunch of people to 6.1 million of those people would qualify for an ACA. Correct. And talk about what does that mean?

00;32;38;08 - 00;32;59;12

Carolee Steele

Well, qualifying for ACA, that is with the health marketplace, Obamacare, like you said, however, you defined that. So those are individual plans or family plans that they may qualify for premium tax credit. What's said is it's monies that the government would give to the carriers on behalf of them for part of the premium because of their income.

00;32;59;25 - 00;33;25;02

Cary HAll

And it offsets your premium, correct. So the number that I saw, I believe was in a Wall Street Journal article, they're just paying the average premium would be $10 a month. Now, here's the thing, and I want you to talk about this Carolee. When you're talking about an ACA plan, like a Blue Cross and Blue Shield plan, the United Health Care Plan and Aetna plan versus a medicaid plan, you just stepped up to a far better insurance plan than being on Medicaid.

00;33;25;02 - 00;33;25;13

Cary HAll

Yes.

00;33;25;27 - 00;33;28;00

Carolee Steele

Yes. Not everyone takes Medicaid for one.

00;33;28;00 - 00;33;28;16

Cary HAll

Thank you.

00;33;29;09 - 00;33;47;10

Carolee Steele

That's critical. It is very critical. And then also to with that, having such a low, low premium, many people qualify for the cost sharing, which means on silver plans, they're out of pocket and co-pays may be extremely low and they qualify that because of income.

00;33;47;22 - 00;34;10;04

Cary HAll

So so this this this this is, you know, a message it needs to get out there, Maria. And people need to know because one of the biggest pieces of this one and you know, there have been multiple articles on this in which straight in financial magazines and newspapers like The Wall Street Journal, etc., But I haven't seen this out in the general public.

00;34;10;04 - 00;34;14;05

Cary HAll

You're not seeing this on NBC? No, CBS. It's not out there.

00;34;14;05 - 00;34;37;00

Maria Ahlers

No, it's not. You know, the marketplace. You know, I've had I've had family members that go on the marketplace and it's overwhelming of information for the ACA plans. Again, call us. Don't be afraid. Call us. Let us help you figure out what the best plan is for you. Let us figure out the subsidy that the government is offering to help offset your premium.

00;34;38;00 - 00;34;55;25

Maria Ahlers

Call the number Get a real live person. The other thing I want to point out to is, is year to year you can speak with the same person carefully, will know your background. Joyce knows your situation year to year. You can call them and say, I need help again during open enrollment and you're not starting all over.

00;34;56;03 - 00;35;00;11

Carolee Steele

And many times their situation changes and so they need an enrollment here.

00;35;00;14 - 00;35;09;05

Cary HAll

When you get that letter in April or March, whatever it is saying your Medicaid is going by by you, you then have the opportunity to pick up the phone right, Carolee?

00;35;09;11 - 00;35;14;00

Carolee Steele

And pick up the phone and call us and we'll walk you through. There's a lot of moving parts to that ACA.

00;35;14;03 - 00;35;32;18

Cary HAll

But and again, you know, this is the thing I really want to get across to you because I don't think you really understand this. This is a step up, not a step down correctly. This is better coverage of what they've got now. Like you said, not every doctor, not every medical facility will accept Medicaid. Correct. Okay. And this changes that dynamic.

00;35;32;18 - 00;35;47;16

Cary HAll

You've got a network now, the Aetna Network, United Network, the Blue Cross Blue Shield Network, the whoever. Okay, whoever is offering the ACA plans and you can move over to it. And that's another thing. They'll see a variety of plans from us.

00;35;47;16 - 00;36;04;09

Carolee Steele

Yes, absolutely. And we will walk through, you know, picking writers, etc.. I think a lot for them is with that 6.2 million people may qualify for that tax credit. So not to worry that they will be able to get robust, you know, coverage for them in the family.

00;36;04;17 - 00;36;28;26

Cary HAll

Yeah, And it's going to be better coverage than than your Medicaid that much we can tell you for sure. Again, you know the biggest problem that the biggest hurdle that we see out there is people not knowing that they qualify. You know, if you live in a community where you've got a relative or maybe you're that person on Medicaid or, you know, somebody that's on Medicaid or they're in your church group or in your PTA and, you know, they hey, you know, I think I'm good.

00;36;28;26 - 00;36;48;07

Cary HAll

I don't know what I'm going to do, want to lose my Medicaid. Hey, you know, what do you they qualify for an ACA plan Call these people. They'll help you. That's what we're trying to get across today is I don't care where you're at. You could be in Tupelo, Mississippi, or you could be in San Jose, California, or you be right here in Kansas City, or you can be in Arkansas, whatever the case may be.

00;36;48;07 - 00;36;55;26

Cary HAll

If you call these folks, they will help you and walk you through the process to get you qualify because there is a process. Right.

00;36;55;26 - 00;37;09;20

Carolee Steele

Currently. And Maria is correct when she said that there is a lot of it can be a very complicated application and, you know, lots of determinations. And that's where we come in, is that we are able to help them through that process.

00;37;09;20 - 00;37;17;03

Cary HAll

And you know that if you know, you're moving from one government trough of one government program and trying to get to another, it's not going to be simple.

00;37;17;19 - 00;37;24;11

Carolee Steele

No, typically not. No. So but that's where our knowledge base collectively that we are able to assist them.

00;37;24;18 - 00;37;48;26

Cary HAll

Yeah, it's going to make a difference. All right. So again, if you want help 877-385-2224. The two topics today were Medicare special needs and Medicaid to ACA. I urge you, if you know anybody that's facing that issue, either one of these two issues that may qualify for one of those special needs Medicare programs, that could make a huge difference in their lives Carolee read off

00;37;48;29 - 00;38;13;29

Cary HAll

all those benefits, zero premiums, all the things from hearing aids to dental to all the rest of it. Take a moment to have them go. Listen to this show on the podcast. Reach out to the folks at RPS Benefits by Design. 877 385 2224 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.

00;38;13;29 - 00;39;17;17

Cary HAll

Truer words were never spoken. Thank you for listening to America's Health Care Advocate Show Broadcasting coast to coast across the USA. Goodbye, America.