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Transcript Ep 2034:

00;00;01;14 - 00;00;05;25

Announcer

And now America's Healthcare Advocate, Cary Hall.

00;00;05;28 - 00;00;30;00

Cary Hall

Hello, America. Welcome to America's Healthcare Advocate show broadcasting coast to coast to Cross, USA. Here on the HIA Radio Network. You can find out more advice by going to the website AmericasHealthcareAdvocate.com. My producer behind the cameras today, Mr. Dave Thiessen, who does a great job of editing all these, posting all these on our YouTube platform with over 450,000 views now.

00;00;30;00 - 00;00;49;10

Cary Hall

Thank you to everybody in this audience, and our 15 podcast channels. So we're it's there's a podcast channel out there. We're probably on it. Everything from Bumble or Spotify to Audacy to iHeart radio. We're on it. So if you want to listen to this on a podcast or tell somebody about it, go up on any of the podcast channels and you'll find us up there.

00;00;49;12 - 00;01;13;19

Cary Hall

In addition to that, I want to, give a shout out today to KFPW AM 1230 in Fort Smith, Arkansas in little Rock, Arkansas. I'm seeing Darren Wilhite over here smile a little bit because Arkansas is, that's where he grew up. Okay. So anyway, once again, hello. All the folks over at KFPW AM 1230 Fort Smith, little Rock, Arkansas.

00;01;13;19 - 00;01;28;00

Cary Hall

I'm glad to have you, as one of our affiliates. And thank you for sharing our show. All right. If you are looking for help with Medicare or ACA, the lovely Carolee Steele can always be contacted. And today, she's right here.

00;01;28;06 - 00;01;29;18

Carolee Steele

Hello, Cary, How are you? Good morning.

00;01;29;18 - 00;01;30;15

Cary Hall

Welcome back.

00;01;30;18 - 00;01;31;07

Carolee Steele

Thank you.

00;01;31;11 - 00;01;32;01

Carolee Steele

Love coming over here.

00;01;32;04 - 00;01;51;04

Cary Hall

So this is our annual, Medicare and ACA show. We're combining both topics today. So we get all this done and get it out there. We're going to talk about open enrollment for ACA, open enrollment for Medicare. We're going to talk about all the moving parts to Medicare this year. Carriers that are out, carriers that are in what's happening with the plans.

00;01;51;04 - 00;02;14;20

Cary Hall

We'll get into all that. And with Carolee Steele here, she is, a certified Medicare expert and an ACA expert. She's been doing this for quite a while, even though she looks like she just got out of high school. She's really been doing this for quite a while. So very happy to have her in here with us today to go over this, disseminate this information to you if you want help, either for Medicare or ACA.

00;02;14;20 - 00;02;35;17

Cary Hall

(877) 385-2224 that's the number of RPS Benefits by Design. We're where you will find Carolee Steele. Also if you are looking for group health insurance. Maria Ahlers over at RPS Benefits by Design is an expert at it. She's been doing it for over 20 some years, and she can certainly help you if you're an employer looking for help.

00;02;35;17 - 00;02;52;12

Cary Hall

But you've got 1099 employees and you don't know what to do with them. Maria's got a solution to that. You might want to give her a call and ask about it. (877) 385-2224. Let's jump in. Open enrollment for Medicare begins on October 15th. Correct. Runs through December 7th.

00;02;52;13 - 00;02;53;13

Carolee Steele

December 7th. Correct.

00;02;53;15 - 00;02;59;11

Cary Hall

Okay. That's a short window. Okay. So if they missed that what happens currently.

00;02;59;14 - 00;03;11;20

Carolee Steele

Then they are stuck with the plan that they have. If they have a Medicare Advantage plan you can move one time during an OEP. But you know it's good to just get everything done between October 15th and December 7th.

00;03;11;21 - 00;03;30;16

Cary Hall

So I remember back in the day people would procrastinate like this. And then we get hundreds of apps in the last 2 or 3 days. And then here's the problem. If the carrier's websites break down and you can't submit, then you got a bigger problem. So we were always urged people take the time to do it now.

00;03;30;16 - 00;03;52;28

Carolee Steele

Correct. And we do have a lot of people that are actually reaching out a little bit early this year and then, but people always will wait until, you know, December 5th, 6th, 7th. And there's a lot of times that this year with, with all the things that are happening in the market, it is imperative to be able to walk through the situation with someone who knows Medicare.

00;03;53;01 - 00;04;06;04

Cary Hall

So let's so let's talk about that. First of all, we've got, you know, a big event here in Kansas City, Blue Cross, Blue Shield Kansas City withdrew from the Medicare Advantage market. So that that leaves who now.

00;04;06;06 - 00;04;30;10

Carolee Steele

That leaves Aetna, United Health Care, Humana, Cigna. If you want to go to the Advantage plan. But I'm glad you brought that up because every Medicare Advantage plan holder with Blue Cross had the opportunity because they are involuntarily losing their coverage, they are able to go to a Medicare Supplement guaranteed issue. That means no health questions if they desire to go back.

00;04;30;13 - 00;04;48;19

Cary Hall

Okay, so this is really important. I didn't even know that they made that decision. So this is a qualifying event. So Medicare Supplements are underwritten. Just so you know, during the window that you're eligible to go into Medicare. They're not under it. You have a one time shot. But if you missed that you've been on the Medicare Advantage.

00;04;48;19 - 00;05;06;23

Cary Hall

Now two years later you want to move to Med Sup, you're going to get medically underwritten. That's the way it works. Well, what's happening here. And this is big news from Carolee is that Blue Cross is they're waiving all that. They're saying. You can come on to a Med Sup regardless of your health etcetera, etcetera, and have coverage.

00;05;06;23 - 00;05;25;26

Cary Hall

And let me tell you something. Laurie and I did all the Med Sup at Blue Cross Blue Shield since we turned 65. I'm 75 right now. My wife has had a broken leg. She's had heart surgery, a host of issues. We have paid nothing. Not a dime. Okay, we are on the plan F. If it's the old plan, it's not available anymore.

00;05;25;26 - 00;05;43;20

Cary Hall

But it has been amazing for us. Okay, so talk a little bit about the Med Sup because I personally you couldn't put me on a Medicare Advantage plan just because there's no network under med sub. You can go anywhere you want to go. So if she needed to go, you know, in Laurie's case, we had to go to Wash-U.

00;05;43;20 - 00;05;52;08

Cary Hall

You know, Saint Louis for a specific heart specialist. It was like we were covered because it was emet. It's Medicare. Anywhere that takes Medicare.

00;05;52;09 - 00;06;16;18

Carolee Steele

That's the biggest, I think benefit of it is any doctor, any hospital, anywhere. As long as they take Medicare from Medicare pays for the service you're having. The Med Sup must pay as well. Right now you're on an F because you turned 65 before 2020. Now there's the top is a G. The only thing that you're going to be responsible for is the B deductible that this year is $240.

00;06;16;18 - 00;06;46;05

Carolee Steele

Next year, maybe 257 I think they haven't determined that yet. But that's your only medical outlay is whatever the B deductible is. However that comes with a premium and they're you know, the premium depends on zip code. Date of birth. Yeah, absolutely. Age. And so if you can swing that and you need the flexibility of being able to go to any doctor, any hospital, anywhere that then their Medicare Supplement, you're able to get on to it this year guaranteed issue.

00;06;46;07 - 00;07;01;21

Cary Hall

You know the Medicare Advantage plans are great for people that really need that kind of a plan, a zero premium plan. They're on a fixed income. They can't afford to do something else. But if you can afford a Med Sup, I will tell you, you will never get Laura and I off of our med stuff with Blue Cross and Blue Shield again city.

00;07;01;27 - 00;07;22;10

Cary Hall

It's been amazing. We've used it countless times. And it works exceptionally well. You do have to buy a standalone D yeah, because D is not included like it is on those Medicare Advantage plans. But regardless of that, overall I think it's far superior to Med Advantage. That's why I never went on a Medicare Advantage plan to start with.

00;07;22;10 - 00;07;39;12

Cary Hall

So let's go back and talk now about the carriers that are remaining in the med advantage market. A little bit. And so you said Cigna, Aetna and Humana. Those are the three big deal here. United Healthcare. United is the biggest one. You know let's talk to so what are their offerings looking like. Are there more out of pockets this year.

00;07;39;12 - 00;07;43;04

Cary Hall

They still offering zero premium or are they pushing up the numbers.

00;07;43;07 - 00;08;07;15

Carolee Steele

Zero premium most. And just to back up to the little with the supplement. I mean some people it's kind of a 50/50. Some people love the way the advantage plan works. Some people love the way a supplement works. It's not like it was in previous years. Okay, they are zero premiums, but, they are not like Blue Cross like, kind of had a little bit of everything.

00;08;07;22 - 00;08;32;03

Carolee Steele

Now it's a lot of them have a drug deductible for tier three, four and five drugs. That's like what you see on TV. Eliquis Ozempic on all of those too. The government has come out with, I don't know if everybody recognize the coverage gap, donut hole, somebody ever so many of you know, always knows what a donut hole is that has been eliminated for 2025.

00;08;32;05 - 00;08;58;10

Carolee Steele

However, the and it's a 2000 max that the member would be responsible for as far as their medications. Okay. So from there, they kind of had to spread the love around. So a lot of the Medicare Advantage plans have kind of pulled back some of their little extra benefits. They've sometimes like I said, put a drug deductible uncertain, you know, a drug.

00;08;58;12 - 00;09;08;18

Carolee Steele

And so it's it's almost imperative that you go to someone who is educated so that they can kind of look to see with your particular situation, not a one size fits all this year.

00;09;08;25 - 00;09;23;29

Cary Hall

Yeah, it does not. And we come back to our break. We will talk more about that. We're also going to talk about all those annoying phone calls you're getting because I'm getting them okay. From people who just want to help you with your Medicare choice. On the same people that you see on television. Stay tuned. We'll be right back after the break.

00;09;23;29 - 00;09;52;13

Cary Hall

You're listening to America's Healthcare Advocate Broadcasting here on the HIA Radio Network. Coast to coast to coast across the USA. If you want to connect with Carolee, I don't care where you are in the country, she can help you. (877) 385-2224 (877) 385-2224 or the website RPSBenefitsbyDesignInc.com. We'll be right back.

00;09;52;16 - 00;10;22;17

Steve Kuker

The golden rule. Treat others as you want to be treated. I'm Steve Kuker and this is one of the founding principles of my firm, Senior Care Consulting. Since 2002, our value statement has included. Honor our mother and father. Respect our elders. Care for those in need. And treat your family as our own. We've been honored to help hundreds of families make one of the most difficult decisions they could ever make.

00;10;22;20 - 00;10;58;06

Steve Kuker

Serving them in their greatest time of need. If you're looking for someone who can provide you experienced and objective guidance when searching for a senior care community, reach out today and discover the services of Senior Care consulting at (913) 945-2800. Know your options and choose with care at SeniorCareConsulting.com.

00;10;58;08 - 00;11;19;18

Cary Hall

Welcome back. You're listening to America's Healthcare Advocate broadcasting coast to coast across the USA here on the HIA Radio Network. This is our annual show on Medicare and ACA, trying to bring you up to speed on everything that's going on with Medicare across the country and also here in the Kansas City metro. So if you're eligible, maybe you're maybe you've lost your plan.

00;11;19;18 - 00;11;46;03

Cary Hall

Maybe you might be in Alabama, you might be in Mississippi, you might be in Ohio, wherever you may be, if you're having struggles, problems finding an ACA plan or finding a Medicare plan, please call Carolee at (877) 385-2224 or their website rpsbenefitsbydesigninc.com. They'll be happy to chat with you and help you.

00;11;46;11 - 00;12;07;01

Cary Hall

All right, so let's talk about this. You know, we you got United, you got Cigna and you got Aetna. And they've all pulled their benefits in. You're not seeing the generous benefits you've seen for the last two years on the ancillary side. So those vision things those dental things like Blue Cross had a thing called Blue Cash.

00;12;07;03 - 00;12;29;26

Cary Hall

You know, Aetna’s had, you know, the over the counter, money for over-the-counter medications, meals and, at home if you needed transportation. A lot of this has been pulled back and it's been pulled back because CMS came down and started squeezing the carriers with more regs. And then the funding was cut back by 3%. Right now, there was pushback on that.

00;12;29;26 - 00;12;51;26

Cary Hall

And then so then, then the Biden administration decided to only cut a back 1% over three years. So I don't know, if President Trump's going to restore that back to where it was or that's has had even been addressed. But the point is, the reason that you're seeing this is the carriers are reacting to what CMS said, just so you understand, because everybody likes to stand up and throw rocks at the carriers.

00;12;51;26 - 00;13;12;07

Cary Hall

And I'm no apologist for the insurance industry, but you need to understand what's going on, not what you think you're hearing. What's going on is that CMS (Center for Medicaid-Medicare Service), change the regs, squeeze down, what the reimbursements were going to be and, and, and cut it back by 3%. And they're doing it at 1% a year for three years.

00;13;12;07 - 00;13;31;13

Cary Hall

If it stands, I don't know if it'll stand when Trump takes office, but it's definitely an issue. So that changes the landscape. How you said, you know, this deductible in front of the medications, a lot of the ways the cost controls are going into play is these formularies. So talk a little bit about what's going on with the formulas United, Aetna and Humana.

00;13;31;20 - 00;13;54;13

Carolee Steele

All of them. Well Humana just not on some but all of them now because there is a limit to $2000 of what the members can pay and the lack of reimbursement from the government. Then they ended up having the tier three, four and five. Like we said, generics preferred generics. They're still going to be zero. The other ones have drug deductibles.

00;13;54;13 - 00;14;11;29

Carolee Steele

So we couldn't can be anywhere from $590 down to $340. And that's what you would o prior to the carrier picking up anything going to like, you know, any type of the the copays for any of those three, four and five drugs.

00;14;11;29 - 00;14;32;01

Cary Hall

So you mentioned a couple. So Humira I'm assuming to be on that list. Eliquis and Eliquis. Ozempic. Wegovi, those are all going to be on that list where you're going to pay and understand where this is coming from, because the reimbursements are cut back the carriers for cost shifting over to the members. That's the way it works, people, just so you understand how it functions.

00;14;32;07 - 00;14;54;10

Cary Hall

And that's one of the areas on the Medicare Advantage plan. You keep in mind that the part D prescription drug is inside the plan, so you don't pay a separate premium for that, which you do with Med Sup, because you have to have a separate, part for part D prescription drug plan. So you don't with the Med Advantage and that it's important to understand that just had a lot of changes there.

00;14;54;14 - 00;15;13;18

Cary Hall

This is why I'm telling you okay. You need to talk to an expert like the people over at RPS Benefits by Design, because you need somebody to walk through this stuff with you. When we walked in studio today, Carolee was talking to Dave, about his formulary and what they're going to have to do to change his plan because he was on a Blue Cross plan.

00;15;13;24 - 00;15;33;19

Cary Hall

So these people that you see on television are these random calls and these people, if you're getting these calls, you know that half these people you're hearing on the phone on the other end can't even speak clear English. They're often a call center someplace, you know, trying to do this. And it begs the question, how are they even licensed to do it?

00;15;33;25 - 00;15;53;12

Cary Hall

They certainly aren't the experts that I'm sitting here talking to at RPS Benefits by Design today. So if you want to trust those people, you go ahead. I don't think it's a really good idea. Okay. I think you're much better off going to a real certified Medicare expert and talk a little bit about that, because you go through training every year.

00;15;53;15 - 00;15;55;00

Cary Hall

It's 21 hours.

00;15;55;02 - 00;16;16;19

Carolee Steele

It's it's probably more than 40, probably 40 hours. And then we have to pass with the 90% or above. And and just so you know, though, I have it, we have a team of people that can help you. And people are not supposed to actually call you. They're not allowed to. We as brokers, must get permission from our Medicare people to be able to speak about Medicare.

00;16;16;22 - 00;16;22;14

Carolee Steele

So they're not supposed to call you. They can't. I've had people who had people come to their door give it.

00;16;22;15 - 00;16;42;11

Cary Hall

But but you, they can call you when they want. There's no okay. Just want to be clear on this. What she's saying is you're not supposed to go out and solicit it. And this is this is. So they do 40 hours of training and the test they pass for 90%. But you will see that. Well, you can go up on the cms.gov website.

00;16;42;11 - 00;17;09;20

Cary Hall

You can sign it yourself. Seriously then why do you have to go to 40 hours for training it? You've been doing this for 10 or 15 years every year and still pass the test with 90%. Because it's complicated people, it's complicated, okay. And it's very easy to get in trouble. And we've had number of people on this show who've been victims of trying to go to the healthcare.gov or the CMS website, bought something and regretted it after they did it because they didn't know what they were buying.

00;17;09;24 - 00;17;32;26

Cary Hall

And I'm telling you, these TV ads and this, these the unbelievable amount of phone calls that are coming in right now, I'm getting 8 to 10 of these calls a day. Okay. So do not talk to these people. Do not because they are not experts. And they're basically out there in these call centers grinding through people so they can get people signed up for these plans, are not doing what's in your best interest.

00;17;32;27 - 00;17;34;18

Carolee Steele

Especially here in the KC Metro.

00;17;34;23 - 00;17;52;20

Cary Hall

They do it every year. It never fails. Okay. But a word of caution to you when you're out there because, it's definitely an issue. So, we're when we come back to break, we're going to talk a little bit about the SNP program that special needs that's available this year. We can talk a little about that and then wrap it up on Medicare.

00;17;52;20 - 00;17;59;20

Cary Hall

And then we'll then we'll start talking about ACA and open enrollment for Obamacare, which starts. Right.

00;17;59;20 - 00;18;00;16

Carolee Steele

November 1st.

00;18;00;17 - 00;18;04;06

Cary Hall

Oh, see there we go to December 15th. Yeah I stand corrected.

00;18;04;06 - 00;18;22;04

Carolee Steele

Every every person who is on a Blue Cross Medicare Advantage plan. They have an extended open enrollment season. There's can go to the 31st now don't wait that long. But if you wake up on the eighth and you're like, oh my gosh, I hadn't been able to get Ahold of anyone, they have till December 31st to be able to move to a plan for January.

00;18;22;07 - 00;18;41;15

Cary Hall

Okay, I didn't know that. So the Blue Cross Blue Shield here in the Kansas City Metro, they withdrew from the market. They you have till December 31st. So you have a little longer to do this nonetheless. (877) 385-2224. You want to talk to the experts at as benefits by Design by Carolee Steele. They are happy to help you.

00;18;41;15 - 00;19;03;14

Cary Hall

The website rpsbenefitsbydesigninc.com. We'll be right back after the break. You're listening to America's Healthcare Advocate broadcasting. Coast to coast across the USA.

00;19;03;17 - 00;19;27;06

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. This is our annual Medicare and ACA show in studio with me, Carolee Steele. She is a certified Medicare expert and a certified ACA expert. You heard her say in the last segment, 40 hours a year of retraining to be able to do this.

00;19;27;09 - 00;19;43;16

Cary Hall

This is not something you should really do on your own. I'm just telling you, but not if you when you've got an expert to be doing this for 15 years and she has to go through 40 hours of training every year and pass the test with the 90, that should tell you something that complexity of this and how difficult it is to do so.

00;19;43;16 - 00;20;07;18

Cary Hall

You want an objective opinion about what's best for you. (877) 385-2224 or rpsbenefitsbydesigninc.com. All right, so a lot of changes this year. Size 44 overcoat as I always like to say doesn't fit everybody explain why and what's going on.

00;20;07;21 - 00;20;33;10

Carolee Steele

Well because of the changes lack of reimbursement from the government. The donut hole of being, eliminated. Not every plan has everything. So, for instance, there's a United Health Care plan that has $3,000 of dental, but it's also got higher co-pays, higher hospital, co-pays higher out of pocket. So if you're okay with that, then you're going to have $3000 on another one.

00;20;33;10 - 00;20;57;08

Carolee Steele

They have lower co-pays. Lower, you know, to the specialist and out-of-pocket. But then there's only two oral exams and cleanings for the year. That's all. So you have to kind of think where am I. Where do I lie as far as what's important to me? So I always say, what are your non-negotiables? What are your non-negotiable doctors? You know, what meds and and what do you have to have going into 2025.

00;20;57;12 - 00;21;11;03

Carolee Steele

Then we can kind of put everything in. And by the way, to piggyback on your training thing, we also have to go through training for every carrier that we're appointed with on top of, on top of what we have to do for CMS.

00;21;11;05 - 00;21;28;29

Cary Hall

So there are a lot of moving parts this year. You just gave a classic example of that's not something you're going to know on your own out there. It is something you'll know if you sit down with an expert and go through it. So there it is. I like the way you did that. You said you're going to find out what their non-negotiables are

00;21;28;29 - 00;21;46;02

Cary Hall

and you're going to back into the plan. Okay. So now we know you absolutely have to have we'll say here in Kansas City, Saint Luke's health system in the plan, or you absolutely have to have KU. All right. Well, which plans are going to allow you to do that? Not all of them are the same. They have different networks, different opportunities.

00;21;46;04 - 00;21;50;25

Cary Hall

The other part is the formularies, which we talked about a minute ago. They're different.

00;21;51;02 - 00;22;11;02

Carolee Steele

They're yeah, they're very different. And one of the, Humana has a couple of plans that don't have a drug deductible for the higher tiers, but they have a medical deductible. So then you have to come up with, with that money before you ever, you know, they pay anything on the hospital and such like that. So it's it's a give and take this year.

00;22;11;02 - 00;22;16;24

Carolee Steele

It's not, you know, a one size fits all. And that's where you really need to be educated to know.

00;22;16;24 - 00;22;39;11

Cary Hall

So what's happening is the carriers are trying to recover their cost, in ways that they haven't had to before because CMS cut the reimbursements. That's really when it comes down to, the other thing that's interesting about this is Medicare Advantage enrollment exceeded original Medicare enrollment for the first time last year. So what I'm saying is there are more people on Med Advantage than there are on Medicare.

00;22;39;13 - 00;22;59;28

Cary Hall

So this thing is hugely popular. But you need to be careful because there been a lot of adjustments this year, and that's what we're trying to explain. So you understand how it works and what's what's to your benefit. What's not. Let's shift gears a minute because this is a piece that gets overlooked. Often they're called SNP programs. What are SNP programs?

00;23;00;03 - 00;23;26;15

Carolee Steele

They're special needs programs. For people who like a D SNP, dual eligible people who have Medicare and Medicaid, we also have C SNPs, which are chronic. So people who are, you know, ill and then institutional. But mainly what we have seen are the D SNP. So people who are eligible for Medicare and Medicaid have quite a bit of, robust benefits on those D SNP plans.

00;23;26;22 - 00;23;33;21

Carolee Steele

So that's what, you know, it's a very good benefit. Huge dental huge. You know, over the counter things and even food allowances sometimes.

00;23;33;22 - 00;23;54;19

Cary Hall

Let's talk about the C SNP plans. They deal with chronic illness if you're a type one diabetic, if you're a heart attack patient, you know, if there are certain medical conditions that allow you to qualify, including if you're institutionalized in a nursing home, you can qualify. So if you've got a loved one out there, you're one of these people in the sandwich generation.

00;23;54;25 - 00;24;08;01

Cary Hall

You've got a loved one in a nursing home or a loved one who's type one diabetic or experienced one of these chronic diseases like heart failure. Whatever the case may be, you can qualify for these plans. And the benefits are very, very rich, right?

00;24;08;01 - 00;24;09;23

Carolee Steele

Robust, extremely talked about.

00;24;09;24 - 00;24;11;01

Cary Hall

Had a little bit.

00;24;11;03 - 00;24;32;03

Carolee Steele

So they can have $3,000 to $4,000 in dental. They can have you know grocery benefit. They just have so many huge benefits that are far superior to your just average, Medicare Advantage plan. Also VA, because I had a couple that, you know, they he gets a lot of things through VA etc., etc., but he wanted to get on to a Medicare Advantage plan.

00;24;32;05 - 00;24;59;25

Carolee Steele

So in case he had to go around the block to a primary care physician. But a lot of the plans, the “Honor”, the “Patriot”, any of those VA speaking of that being veterans, the VA, they get a kickback or a give back from their part. B so he had a lot of things covered. And so he's, he gets like $75 to give back to his part B, which reduces that premium and increases his social security.

00;24;59;28 - 00;25;17;08

Cary Hall

So what we're saying is you can keep your VA benefits and get a Medicare Advantage plan. And that's why these plans are called the honor plans. There's a whole series of names for them. Different carriers have them. They allow you to stay on the VA and use that, use the prescription drug portion, the VA, which is free.

00;25;17;10 - 00;25;35;02

Cary Hall

You don't pay for it. I'm a VA card carrying guy. It's free you if you use it. I don't use it. But a lot of people obviously do. You can keep the VA drug benefits and simultaneously go on a Medicare Advantage. So you have care outside of the VA if you choose to do it. So it's a big deal.

00;25;35;04 - 00;25;53;00

Cary Hall

And a lot of people don't know that's out there. So there's three of these programs, you know, about the C SNP program for people with chronic illness that can qualify if they're if they are institutionalized, if they have type one diabetes, heart failure, whatever the if they're on dialysis, whatever the case may be, they can qualify for one of those programs.

00;25;53;00 - 00;25;57;11

Cary Hall

There are no out-of-pocket. They're great. They don't cost him anything. And they're no out-of-pocket.

00;25;57;11 - 00;25;57;29

Carolee Steele

On the D SNP.

00;25;58;05 - 00;26;18;16

Cary Hall

Correct. And and and on the and on the C SNP. So that's important to know. And those are opportunities. But you're not going to know about that if you don't talk to somebody like Carolee Steele (877) 385-2224. She is happy to help you along with all the folks over at RPS BBDI. All right, let's switch gears. We got to the rest of this segment.

00;26;18;16 - 00;26;25;16

Cary Hall

Next segment. Talk about ACA. Open Enrollment for ACA started November 1st and rolls through what?

00;26;25;19 - 00;26;29;06

Carolee Steele

And December 15th for January effective date.

00;26;29;08 - 00;26;49;08

Cary Hall

However, in the last two years, the Biden administration has extended the deadline into January for February enrollments, we don't know that that's going to happen. I have every reason to believe it will be. I can't imagine President Biden wouldn't do it again like he has done in the past. But but you could be cut off on December 15th if you haven't enrolled.

00;26;49;08 - 00;26;52;00

Cary Hall

So there's a lot of moving parts in ACA.

00;26;52;02 - 00;26;52;21

Carolee Steele

Lots of moving parts.

00;26;52;21 - 00;27;00;25

Cary Hall

Moves. Okay. Let's talk a little bit about that. And the different carriers and what they're doing and what you need to know out there. Have subsidies gone up again this year a little.

00;27;00;25 - 00;27;01;08

Carolee Steele

Bit.

00;27;01;11 - 00;27;02;09

Cary Hall

Okay.

00;27;02;11 - 00;27;19;25

Carolee Steele

But I think it's it really depends on, you know, where you live. How many are in your taxable household and then, what your gross income is and that determines what your subsidy is. It's moneys that the government gives to the carrier on your behalf or part of the premium.

00;27;19;25 - 00;27;22;03

Cary Hall

So why does where you live have anything to do with.

00;27;22;03 - 00;27;28;08

Carolee Steele

It know it's definitely state driven and you know it absolutely. ZIP code date of birth, all of those. Yeah.

00;27;28;14 - 00;27;33;28

Cary Hall

Okay. So you would get a different reimbursement from Kansas versus if you're in Missouri.

00;27;34;03 - 00;27;55;27

Carolee Steele

Correct. And the fact that it is, you know, there it isn't just like well, how much would I get? Well, it depends if you're 25, 45, 62, you know, the their reimbursements are completely different. So we would have to know what is your I had a woman come in and she's like, well this is all I make. And I said, no, it's your taxable household.

00;27;56;04 - 00;27;59;01

Carolee Steele

So that's where we come into play is look at those.

00;27;59;03 - 00;28;01;23

Cary Hall

And that means husband and wife, bring it in.

00;28;01;25 - 00;28;19;07

Carolee Steele

Whatever. Yeah. What whoever you file, if you claim someone it then is a taxable. Let's say you have two kids claim it's a taxable household for because you claim two people and it's the income over four. So makes a huge difference how you put everything in to be able to get that correct subsidy.

00;28;19;08 - 00;28;44;03

Cary Hall

And this is I urge you, please, you know, we had a young lady come on this show some time ago who very bright, very bright lady, she was a smokejumper for the National Forest Administration. And she got pregnant. She went out and signed up for health insurance online at, healthcare.gov with one of the navigators, who navigated her right into the middle of hell.

00;28;44;06 - 00;29;02;29

Cary Hall

Okay. Because she went back to change her maiden name, to her married name. And they canceled the plan on her because they didn't know what they were doing. It took us six months. Six months. With the help of Angela Kono. Wolford, channel nine. For us to raise enough sand about this to get them to reinstate her plan.

00;29;03;06 - 00;29;22;26

Cary Hall

And then they wanted her to pay the back premiums. So, again, you're much better off using somebody like an expert like Carolee Steele and the folks at RPS Benefits by Design. Number one, they'll find out what your subsidy is. Number two, they'll tell you how to qualify for it. Number three, they help you do the paperwork. We'll be right back after the break.

00;29;22;26 - 00;29;37;25

Cary Hall

You're listening to America's Healthcare Advocate broadcasting on the air. I radio network, coast to coast across USA. Stay tuned. We're going to wrap it up in a minute.

00;29;37;27 - 00;30;03;02

Cary Hall

Welcome back. You're listening to America's Healthcare Advocate show broadcasting coast to coast across the USA. You can find out more about us by going to our website, AmericasHealthcareAdvocate.com. All these shows are posted on our YouTube platform and all 15 podcast platforms. So if you're listening to this, maybe you want to tell you maybe you've got a parent that has got a chronic disease and they could do the C SNP program, or maybe they qualify for the

00;30;03;04 - 00;30;10;21

Cary Hall

S SNP program. So to that point about this being complicated, you told a story when we were on break. Tell us that story. It’s a pretty good story.

00;30;11;07 - 00;30;13;05

Carolee Steele

He was an engineer. He built bridges.

00;30;13;07 - 00;30;14;13

Cary Hall

Okay. That's pretty smart, guys.

00;30;14;13 - 00;30;28;29

Carolee Steele

It's a smart guy. He was delightful. And so we talked about all of this. And he goes, there are so many moving parts. And he goes, he goes, there's no way I could figure this out on my own. And he goes, I feel pretty intelligent. I go, you are, you go build the bridges. I'll take care of Medicare.

00;30;29;02 - 00;30;48;06

Carolee Steele

So he was great. Yeah. But he just thought, there's so many moving parts, man. And here's the problem. If you pivot incorrectly, you can really haves. And I always say, you know finances and health is right underneath God and family. That's and that's the responsibility that is on their shoulders just to get this right.

00;30;48;08 - 00;31;13;01

Cary Hall

Yeah. And the problem is if you go and you go into an ACA or a Medicare Advantage or another plan, and then you decide you don't like it, you're stuck. You're not getting out, okay, until the next year when open enrollment happens again. So that's why doing it the first time, the right way so that it doesn't wind up costing you money and making your life difficult because a oh, I didn't know that hospital wasn't in there.

00;31;13;04 - 00;31;28;17

Cary Hall

You know, they always tell the story when you get these people on the phone and you tell them, they call you about Medicare. So can you tell me the the hospitals are a network on the other side of the river, and then they come back to you and go, what river? You know, you're talking to somebody sitting in the call center in Guatemala.

00;31;28;23 - 00;31;52;18

Cary Hall

Okay, that doesn't know beans from apple butter about what? They're what they're supposed to know, which is the networks, the doctors, the hospitals, what's available. And I personally don't you don't think it's guaranteed trust your outcomes to people like that, that really don't know anything is sit in these call centers and churn through calls looking for people to hook and then get, bring to the table and, and get them to sign up for these plans.

00;31;52;24 - 00;31;53;21

Cary Hall

It's just not done the right.

00;31;53;22 - 00;32;17;17

Carolee Steele

No. And I even even educated, seasoned people still have to pay attention to everything that is changing. So we have to be up on everything, and we still have to, you know, go to the carrier, go to somewhere to make sure that what we are saying is absolutely correct. And that's why. But piggyback on that. You know, you said something about the D SNPs Medicare, Medicaid, a lot of people don't know even exists.

00;32;17;17 - 00;32;31;08

Carolee Steele

Well, and they go, well, I've already got Medicare, Medicaid, I don't really need that. And I thought, you are leaving so many amazing benefits. You done on the table. Yeah. And that's why, you know, we know those things that we can assist with them and they need them especially the D SNPs.

00;32;31;11 - 00;32;46;12

Cary Hall

They they really do. Because again, you don't know what you don't know. That's that's the key part here. So so you know, as we come to close on the show today then what what it what you know, first of all we've got all the folks out there that are on these BlueCross plans here in the Kansas City metro.

00;32;46;12 - 00;32;56;09

Cary Hall

I think there are 35,000 of or something, obviously, they're going to need help so they can call you. Okay. And you're more than happy to help them with it if I.

00;32;56;09 - 00;33;08;24

Carolee Steele

Can't, which, my bandwidth is pretty tight right now, for sure. Thank you. Dave, though. But we have a team of people that are just as educated and just as knowledgeable where we can have them go over the plan options.

00;33;08;24 - 00;33;27;11

Cary Hall

The point is, if you need that help, you can get it at RPS and here's the thing they're carrier agnostic. It doesn't matter. You know, if you think you know any plan fits better. And you sit down with one of the RPS BBDI people and they say, you know what? This formula gives you exactly what you want. Know the benefits here that are ancillary.

00;33;27;11 - 00;33;43;25

Cary Hall

They look pretty good for you dental, vision, etc.. Okay, maybe it's the Aetna plan or maybe it's a Humana plan. With the access to their walk in clinics, they've got their own clinics. So, you know, maybe but you don't know those things. If you don't sit down with somebody that really knows what they're doing.

00;33;43;25 - 00;34;09;00

Carolee Steele

And bottom line, we really take care of people. I mean, that's our whole goal is to take care of people, not put a number on the board, but we truly take care of people. Some people love the way the advantage plans to work, and that's why we pivot and get them something that fits them. Some people love the supplement and then we kind of address that, but we definitely need to go over, like I said, the non-negotiables, what is important to them so that we can take good care of them.

00;34;09;03 - 00;34;26;11

Cary Hall

Yeah. Because again, you don't know what you don't know and you don't want to make a mistake and do something that's going to wind up costing you money, okay? And not giving you the kind of coverage that you want when you have a situation. Here's the other thing. You know, we used to have a commercial back in the day when, I ran benefits by Design.

00;34;26;12 - 00;34;43;09

Cary Hall

It said you can call the one 800. I don't give a damn number at the carrier. Or you can call us. Well, the reason I made that commercial was people would call these carriers up and go to, you know, five or 6 or 7 voice prompts and try to get somebody to help them with the claims issue or provider issue.

00;34;43;09 - 00;34;52;18

Cary Hall

And they couldn't get it. And they were very frustrated and very angry. And so we would tell our clients upfront, don't call the carrier, call us. You're telling them the same thing, right?

00;34;52;18 - 00;35;08;29

Carolee Steele

Carolee well, and I always say with us being an agent of record, we can kind of do do something with the carrier on their behalf where, you know, if somebody has a I had a guy that had a knee replacement, I think we talked about that before. And, you know, they were saying we could they couldn't get it to go through.

00;35;09;05 - 00;35;14;28

Carolee Steele

We had a peer to peer and it was a they, they needed some type of

00;35;15;00 - 00;35;15;23

Cary Hall

Authorization.

00;35;15;23 - 00;35;21;19

Carolee Steele

Yeah. Author's a and so instead of being able to do that, he said it's bone on bone when we got it. Okay. And he was done on Monday. You know.

00;35;21;19 - 00;35;41;16

Cary Hall

Here's the other thing. These carriers all have portals for brokers and agents. So they have a separate way of getting in touch with somebody. They can solve the problem where they can go right in and say, hey, I've got client, the client that needed the knee replacement, same situation. They're able to go in interface. She said. They set up a peer to peer meeting.

00;35;41;16 - 00;36;00;05

Cary Hall

They got it resolved and got done. You're not going to be able to do that. You're going to get frustrated and angry and you're not going to get the results you want. So my point in telling you all that is take the time to use these folks. They're experts at what they do and they can help you. Once again, open enrollment for Medicare is October 15th.

00;36;00;05 - 00;36;01;09

Carolee Steele

To December 7th.

00;36;01;09 - 00;36;21;23

Cary Hall

December 7th. That's it. If you are on that Blue Cross plan, it's extended until December 31st here in the Kansas City Metro. And anywhere in the country where a carrier has pulled out, you would more than likely have that same opportunity. But you need to call and ask that question. Let Carol help you. Okay. And then the ACA, once again is November 15th.

00;36;21;23 - 00;36;22;20

Carolee Steele

November 1st.

00;36;22;23 - 00;36;23;14

Cary Hall

November 1st.

00;36;23;19 - 00;36;28;25

Carolee Steele

Through December 15th for a January effective date. And sometimes they'll do for January 15th of February.

00;36;28;26 - 00;36;52;20

Cary Hall

Okay. (877) 385-2224 anywhere in the country. They're happy to help you. The website RPSBenefitsbyDesignInc.com. And now I leave you with this thought from Doctor Martin Luther King. Americans must learn to live together as brothers and sisters, or we will surely perish together as fools. Truer words have never spoken. Thank you for watching and thank you for listening to America's Healthcare Advocate today.

00;36;52;22 - 00;37;00;07

Cary Hall

Goodbye, America.

00;37;00;09 - 00;37;04;13

Cary Hall

And you?