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E11: Don’t Do Medicare Alone with Dana Lasman, aka MedicareDana

Medicare Annual Enrollment Period (AEP) begins Oct 15 - Dec 7th.  Don’t Do Medicare Alone with Dana Lasman, an independent Medicare insurance Agent

Friends Don't Let Friends Do Medicare Alone 

with Dana Lasman

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MedicareDana.com will walk you through your seniors or person with aphasia medicare benefits
Check Out Dana's Informative Website

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TRANSCRIPT

Genevieve: Dana Lasman is joining us this evening, and her handle is Medicare Dana, which I absolutely love is your website name.

No one will forget it. So Dana Lasman is an independent insurance agent specializing in Medicare, which is right up my alley. Dana resides in Austin, Texas and holds licenses nationwide, and can service clients throughout the United States. Woohoo. Do you hear that, all my peeps out there? Dana is passionate about Medicare education so that those who are eligible for Medicare have all the resources to make an informed decision and ultimately protect their health and wealth.

I love that. It's a good bio Dana.

Dana: Thank you.

Genevieve: Thank you for joining me this evening. I'm so grateful to our mutual friend, Mary Osborne, YourDementiaTherapist.com, for introducing us because your website is chock-full of incredible information that most of our folks that are Medicare eligible haven't ever read before.

Dana: Well, thank you. It's a pleasure to be here. And I love that we're both in the senior space and that we're both so passionate about getting seniors education and resources in ways that are really ethical and that are really valuable. And I think that’s really, really missed in the community right now.

And it's so nice to meet other people that are really striving for that within our population. I'm so grateful to Mary as well, and I love to be able to provide valuable resources for our community.

Genevieve: Wonderful. So let's jump right in. You are an independent Medicare agent. What on earth is that?

Dana: Good question.

Independent Medicare Insurance Agent

So, there are two different options. When you're an insurance agent, you can be captive or independent. If you're captive, it means that you work with one insurance company. You are gonna always be offering that insurance company solely. If you're independent, you can write and do write with multiple carriers, and ideally, then can shop a full market and offer different plans with different carriers.

And the reason why I chose to be independent is that, especially within Medicare, some of the Medicare plans are standardized, which means across the board in any state, they're the same coverage and the same benefits, but the insurance carriers can charge varying premiums.

So, especially for seniors that are on a fixed income, if they're getting the same products, one company charges significantly more than the other, that's important for the consumer. And we wanna be able to showcase that. The consumer should know that ahead of time and then be able to choose which carrier they might like, a particular carrier that charges more. And I think, you know, your decision is your decision, but have the education behind it.

And so I think that being forthcoming and being really transparent about that is important. As an independent agent, I can do that. Additionally, each year when you do have whichever plan you're on, the rates can increase. As an independent agent, one company might increase their rates very high one year, so depending on the person's background their medical needs, they might be able to switch to that exact same plan but with a different carrier and save money that month.

And for the month, you know, going on for the rest of the year. So to be an independent agent, there are a lot of options that you have to cater to the client versus catering to an insurance carrier.

Genevieve: Okay. So there's a lot to unpack there. I have some questions.

Dana: Sure. Fire away.

What is Original Medicare?

Genevieve: Let's get into this because not only am I a Medicare part B provider, I provide outpatient therapy. So boy, I've had the steepest learning curve being a clinician and offering it. But, you talked about different carriers, so that's where I wanna start with. Because if I have a client coming to me and they've got the white card with the blue and red like swoop on the top that says Medicare, aren't they directly involved with the federal government, and the federal government is paying their benefits?

Dana: Yes, but also maybe no. So that card that you just specified, the blue and white card, that is the Medicare beneficiary identifier, MBI number, and their Medicare card, that's gonna have their part A and part B on there. Anyone who enrolls in Medicare enrolls in parts A and B.

However, pay attention. You then have the option to get a supplement to go along with your original Medicare OR get a Medicare Advantage plan. The original Medicare, which is parts A and B, doesn't fully cover someone. There are a lot of gaps. And the gaps can be really, really pricey, and they can expose someone to very high financial bills. And so, most people either go the route of going with original Medicare and supplement OR Medicare Advantage.

These are two totally different programs, which makes for a lot of confusion. So, if someone is handing over their original Medicare card to you as their provider, or for any doctor that's the provider, then they're under original Medicare, and usually, they have a supplement plan to go with it.

If someone is on Medicare Advantage, the Medicare Advantage plan actually takes over the coordination of A and B. Those people actually tuck that Medicare card away. They don't need it. They don't give that to providers. They give the provider just the Medicare Advantage card. And that gets paid through the third-party insurance company that's managing the Medicare Advantage plan versus your client that gave you that original Medicare card is getting their services paid via the federal government.

Genevieve: Right. And typically, when you're for somebody coming for outpatient speech pathology, original Medicare Part B pays 80% of what is the allowed rate, and then the supplement, if there is one, picks up that additional 20%. And that's just for outpatient therapy, and we're not talking hospital bills. That's what you're talking about, the scary part of making sure your financial house is in order. If you have that unexpected hospital stay and you get this ginormous, and that is my word, ginormous bill. I've seen them. They are scary.

Dana: Yeah, and that's why I stress so much about education.

Learn about Medicare When You are 64 Before You Enroll

When someone is 64, 64 1/2, start learning the program because there are lots of different rules out there. There are different circumstances for different people depending on if they're working, but then it depends on how large of a company they work for and what type of group plan. Are they contributing to an HSA or a health savings account?

All of this plays into whether or not they should enroll in Medicare and whether or not they'd get penalties if they enrolled at certain times. So it's really not super straightforward, which is why it's so important to talk to an expert in Medicare, but also why education is important because the original Medicare plan and the Medicare Advantage plan are so different.

They are different programs, and they have different coverage, they have different benefits, and different costs. And if someone isn't aware of what their options are. They choose one of those plans without knowing either you know some of the fine print or some of the things that aren't covered, and then realize that after the fact, which usually happens when they get a diagnosis or they need treatment, that it’s not covered, right?

Just like you find out that you don't have rental car insurance on your auto policy when you're in an accident, and you need to go rent a car for six months while it gets fixed. If you find out after the fact that you need medical coverage and the plan that you chose doesn't have it, you're most likely gonna be declinable to switch out.

And that's the part that's actually so heartbreaking being in this industry is that people weren't educated on the front end when they were making their decision, and then they find out on the back end that they are stuck.

Don't Let This Happen To You

Genevieve: Wow. So that brings me to a story. I started with one of my clients being on Medicare towards the end of last year. And I checked his benefits when we made the calendar transition to January 1st, and we were good to go. He wasn't receiving any other services, so I knew that what I was seeing as far as his eligibility was all good.

What we neglected to find out, and we almost didn't find it out, just a little personal story, I was fighting with submitting telepractice claims for folks in other states, and it was again that the learning curve was steep. So there was a delay in me realizing that his particular claims were coming back denied saying that there is no benefit for this person. But yet, when I looked at Medicare eligibility, it's right there.

So, being new to the whole system, anyways, I digress. What we found out when I talked to my patient's wife was that she had signed up for what she thought was like a pharmacy benefit. Part D, I think, is correct. You'll have to talk to us a little more about some of those other parts. But what she had signed up for was an Advantage plan that didn't cover speech therapy at all.

So luckily, we caught it in time. We were able to of us do some research and guide her because she wanted to stay on Medicare. The pharmacy outlay was not that extensive. She just thought, ‘Oh, this looks like it would be good. I'll just add it on. But it changed her whole plan. Anyway, we got it sorted before that March 3st deadline.

Dana: So lucky that you found it when you did and were able to get it sorted. Now, this type of thing happens a lot, and this is the exact example that I was just saying of how different the plans are. When you were saying that someone might give you an original Medicare card, Medicare Part B pays for 80% of the original Medicare, and the patient's responsible for 20%.

Now, we don't ever suggest someone just go on original Medicare because of that exposure of 20% on part B. Part B is anything that's not admission to a hospital or skilled nursing facility. That's an outpatient facility, anything that you go to a doctor for. So, for example, it could be dialysis or chemotherapy, and 20% of chemotherapy is a huge colonoscopy. I mean, anywhere that you're going where you're not admitted falls under part B. That exposure is just huge.

Medicare + Supplemental Insurance

So, someone who's got, potentially, original Medicare and then a supplement plan chose a supplement plan to cover those gaps. And many of them cover that 20%. That would be the original Medicare

Someone who's on a Medicare Advantage plan is gonna have different benefits, and they may or may not have the same as original Medicare and a supplement. And many times, they're not the same, and they're able to negotiate and change what they get each year. That's what is actually coming up, AEP (Annual Election Period). It’s the one time of year for folks in the Medicare Advantage plan or prescription drug plan that they can make a change because they're not standardized, and they're renegotiated, and you have to keep up with it.

What's changed or what's not? Are the benefits changed? Is the coverage changed? Has the cost changed? Because otherwise, you might think that you have certain coverage. Come to find out, and you don't because the plans changed.

But the difference between the two programs is so great. As you just saw with your client, under original Medicare, you would've had complete coverage, and under Medicare Advantage, none at all. And that out-of-pocket cost for your services and many others is outrageous. So, it's really important to understand the program and have that education so that people can make informed decisions.

Genevieve: So let's just cover the parts of Medicare just so we’re all on the same page. And then, we need to talk about the AEP and define that and be explicit about the dates and what people need to do. And I just wanna throw out there that we're probably gonna say it at least three times in this episode. Don't do Medicare alone.

Don't Do Medicare Alone

This is my takeaway. There are agents like yourself that are knowledgeable and experienced and can help solve these problems, give the education, and help you formulate a path for what you and your partner and your family need under Medicare.

Dana: Definitely, and I would even say to people listening, if you're not of Medicare age, ask your parents or your grandparents. And you know, sometimes parents are a little bit more restricted. They may not want to talk about their health, and they, you know, it's that pride, which I completely understand…and grandparents are a little more open to talking about it. But just ask if they have an agent that they talk to or that they call, or that talks to them.

Anyone who's on Medicare should have a dedicated agent committed to customer service that is getting in touch with them every year, especially during AEP, which we'll go into a little bit more, but getting in touch with them, letting them know of any changes that are happening and that those people if they have questions, have that agent's phone number and can call them.

There are so many people out there that don't have an agent. Someone might not have an agent for two reasons. One, maybe they signed up for Medicare by going directly to an insurance company on their own. And so, if they go directly to an insurance company and you don't have a dedicated agent, you definitely don't have an unbiased dedicated agent, but that might be one reason.

Two, and then others signed up and that agent, unfortunately, and there's many of them out there, never got in touch with them. They sold them a policy, and that was it. So, if that's someone’s case, they don't even know who their agent has been for ten years.

There are a lot of us that are in the community that is licensed nationwide that can help. Or, even if they're not licensed nationwide, most reputable agents have a network. They can at least put someone in touch with an agent in another state so that they know the person is taken care of versus just cold calling an agent that you don't know if they're going to give you accurate information or not.

Genevieve: I hate to confess, but I actually didn't know there was such a thing as a Medicare agent.

I just thought it happened. You're 65, and you retire. Here's your Medicare card. Go, go live, fly, and be free.

Misconceptions about Medicare

Dana: I think there are a lot of misconceptions out there about Medicare. And some clients even think it's free.

People that are turning 65 because you pay into it and you do, and people pay into it. You pay into it with your FICA taxes, but it's still not free. So that's something that is, for some people, a rude awakening as well. And it's so important, again, to start talking about this early because we're talking about financial planning, we're talking about people's income, and a lot of them are on a fixed income.

And if they thought that Medicare was free and then they learned that it's not, that goes into their everyday spending. I also work a lot with financial planners and wealth managers that are looking at planning for people's retirement because Part A, which you did say we wanted to go over, Part A, covers hospitalizations.

Medicare Part A: Admitted

So Part A is gonna be a skilled nursing facility, home healthcare, and hospitalization. I like to say, think of someone being admitted. “A” admitted. So if you're admitted to a hospital, if you're admitted to a skilled nursing facility, if you're just in the hospital and you're getting observed, and you don't actually get admitted, that's not part A, that's actually part B.

So, A is admitted, and part A is something that, if you are eligible for premium-free by working 40 quarters, then you get that for no cost. I don't like to say free cuz you have paid for it. It's no additional cost per month because you've paid into it during your working life.

Medicare Part B: After the hospital

But part B, which is basically everything else, is your outpatient, ambulatory care, lab work, and anything where you go outside of being admitted. Again, remember that A is covered. And under Part B is what you pay for. The premium in 2022 is $170.10, but it's based on income. It's based on income for an individual of $91,000 or less and for a couple of $182,000 or less.

So, high-wage earners actually get an additional charge called Irma, which stands for Income Related Monthly Adjusted amount. People that are high-wage earners depending on their bracket, and there are a bunch of different ones, get a higher charge, and it's something that's not really talked about that much out there.

So a lot of people came to wanna join Medicare and get shocked by these Irma charges, it increased the cost. Again, it's so important to talk to an expert and to start planning early. And it’s why I work a lot with financial planners because the ERMA is really something that needs to be looked at and planned out.

IRS looks at your income taxes from two years prior. They do a two-year look back, and if you're a dollar over, you can have this large charge. So it's just that important. And it's not to do anything unethical ever. Still, if you're planning on removing some money somewhere, and it doesn't necessarily affect your bottom line, you might wanna wait to take it out of whatever account.

It's important to know what the rules are for those Irma charges. ‘Cause people have moved money before that they didn't necessarily need. They just wanted to take it out of, like, whatever it might be in their retirement planning and put it into liquid form, but they might not need it until a couple of years.

And now, because of that, because it was taken out and is on their income tax return, they are spending an extra $300 to $500 a month on their Medicare. And so, it's just that education, that knowledge, and knowing how to prepare and what some of the rules are. ‘Cause if you don't know, you don’t know.

Genevieve: And that reminds me that with the turning of January 1st, there's going to be Medicare deductibles that some folks get surprised by, especially if they're brand new and every year they change.

Dana: That’s right. So, it's why it shocks me that agents will sign someone up and not talk to their clients and never have anything to do with them, especially during that first year on Medicare. My clients are calling me all the time, and I'm educating them because the Medicare program is very different from individual and group insurance that people are on their whole life. Once you get on it and understand it, it is pretty easy to understand.

But it takes a while. Just like anything else. Change is tough for anybody. Think about being on one plan your whole life and then come age 65 or, maybe, 75. If someone has been working on a group plan, and again, if they're under the right circumstances, they might not have needed to get Medicare at 65.

They might have been able to wait, and they're on this brand new program, and it's confusing, or they're getting bills, and they don't really understand exactly what it is. What do they have to pay? What don't they have to pay? Where do they find information? Your agent is your point person. I am my client's point person, no matter what, regarding Medicare, and I want them to call me.

AEP: Annual Enrollment Period for Medicare

Because right now, what you'll start seeing AEP (annual enrollment period), which is the annual election period, is coming up, and there are advertisements on the radio and on the television everywhere, all over, and people who are 65 and older get bombarded by phone calls. They don't know what's what. Even the most intelligent people it has nothing to do with that.

It's just they are designed to confuse you, and they are designed to make you question what's going on to potentially switch you to a different plan. And so I have a lot of clients that will call and say, Is this real? Is this right? Someone told me that they're calling for Medicare. And by the way, Medicare does not call you.

They will not call you ever. So someone says, I'm calling for Medicare. That's a huge red flag. Someone might be calling from a Medicare division of a company, but it's not Medicare, and that's confusing to seniors. It would be confusing to any of us.

Genevieve: Yeah. Going back to my example of my client that signed up for an advantage plan, she saw it on the Medicare website.

She showed it to me, and so she thought it was just original Medicare with this extra drug benefit. And so that, for her, was really confusing and a sticking point. So, good points.

Medicare Part C: Medicare Advantage Plans

Genevieve: Is there Medicare part C?

Dana: So, Medicare Part C is Medicare Advantage. So, part A and part B are original Medicare.

And that's what anyone who is eligible enrolls in. A good distinction that people also don't realize is that you have to pay for your part B premium regardless if you get Medicare Advantage or if you get a supplement plan. So paying for that part B premium happens regardless.

When you enroll in Medicare, you have to stay enrolled in Medicare parts A and B. If you decide to enroll in a Medicare Advantage plan, which is part C, then you have to make sure that you're still keeping up your payments for part B. Otherwise, your part C would get removed. Because it's only viable if you have part A and part B in good standing.

Medicare Part D: Prescription Drug Plan

Dana: So that's something people don't realize; part C is Medicare Advantage. And then Part D, which we haven't talked about, is the prescription drug plan. Now, under original Medicare and the supplement, people would enroll in a standalone prescription drug plan. If people choose to enroll in Part C, which is Medicare Advantage, many times they will bundle that with a prescription drug plan.

Those plans are called MAPD Plans (Medicare Advantage Prescription Drug Plan). They bundle it all in one. There are some Medicare Advantage plans that have standalone prescription drug coverage, but many of them bundle it, so that's also the difference. Now, some people enjoy having all of their medical and prescription drugs in one bundle together.

What I think is that it's convenient for people. But what I think makes a standalone prescription drug plan really nice outside of the medical, under original Medicare, is that it can be customized to the actual medications you're on. So, Medicare Advantage Plan, with its drugs, will still be somewhat customizable, but you have to get a plan that has the medical part and the drugs all in one.

Where with the supplement plan, you can have your straight medical plan that covers its nationwide coverage under the supplement plan. Basically, you can go to any doctor, any specialist. There are no pre-authorizations, no prior approvals for original Medicare, and a supplement as long as they accept original Medicare.

So, you travel, and Medicare and the supplement plan travel with you. You don't have to wait on anyone to approve or deny it. No third party to kind of accept that. And the prescription drug plan is catered to as well. So, drugs are tiered, tier one through six. And so, if someone's on really high-tiered medications and someone's on really low-tiered medications, they're most likely not gonna have the same prescription drug plans.

The prescription drug plans all have a formulary to list medications. But that particular plan covers different costs and percentages of how they cover them. So, some drug plans cover high-tiered medications really well, and others don’t.

Say someone's just on tier-one generic medications. They're gonna be on a different prescription drug plan than someone that either might have a mixed bag of a bunch of different tiers or higher prescription drug plans. And each year, as your drugs change, as your medical ailments change, your prescription drug plan will change too. So, you can kind of customize each year with that standalone.

Genevieve: But only once a year during AEP (annual enrollment period)…I'm learning my lingo.

Dana: So, one time to change the prescription drug plan, the Medicare Advantage plans and the prescription drug plans have a lock-in period. And that's because they're renegotiated every year. And the coverage, the benefits, the premiums, they all change.

Again, just to reflect back on the supplement plans, they're standardized. They don't change every year. So you don't have a lock-in period. You can make a change to original Medicare and that supplement plan any day of the year,

However, you have to pass medical underwriting. So that also goes way back to the beginning when someone is enrolling in Medicare. It's the most important for me, at least, to get to them or for an ethical, qualified agent to get to them to talk through all their options. Because that time period is also the first and only time unless they are in a special enrollment, which there are not very many, that they have complete access to a supplement plan without medical underwriting or any recognition of pre-existing conditions. And that's huge.

You know, it's not every medical condition, but there are certain ones that are always gonna be declinable. And then there are certain ones that are declinable within certain windows. So cancer diagnosis isn't always declinable. But depending on the carrier, it's either three to five years of cancer-free and, depending on how stable your medication is, things like that.

So, it's not a forever diagnosis that you can't get underwritten, but it just depends on the circumstance. So it's really important, especially if you have health issues. Which decision, which program you go into, and understanding what these gaps might be in the different programs because some of them are great.

Genevieve: I think number one, I'm just gonna pick a scene. I'm just gonna say senior age or Medicare eligible. They kind of need to know what their medical history is and be upfront about it with you if you are their agent so that you can help them make the best decision for their coverage.

Dana: Yeah, I would say yes and no. I mean, typically, I have a relationship with my clients where they can pay anything. I mean, there's nothing probably more confidential than your medical and financial future. Right? But if someone doesn't wanna be completely exposed, let's say, what's going on with them, they need to be able to understand at least the impact.

If you do have a medical issue, then you may not be able to switch out of this plan because you might be declinable. And what that means to that person, ideally, is being open about what they have medically is really important. If anyone would pass medical underwriting, they have to be open about that.

There's a slew of questions that do ask very specific medical questions that we have to go through. So that means if someone is, let's say, 70, and maybe they're on a Medicare Advantage plan like right now, it's AEP. Coming up October 15th to December 7th is the one time of year to make a change to your prescription drug plan.

It's also when you can enroll, disenroll or switch from a Medicare Advantage plan. So if someone was in a Medicare Advantage plan and realized that they didn't like the coverage or they didn't feel like they got the procedure that they wanted, it was declined or whatnot, they have the opportunity during this time period to change.

Again, it's from October 15th to December 7th to switch back to the original Medicare. But in order to do that, they have to pass medical underwriting. In order to pass medical underwriting, this would be the time, Genevieve, that they would have to be open about their medical background and answer a slew of questions that I would go over with them so that we'd even know if they even could potentially pass it.

We wouldn't put someone through to the medical underwriting team of an insurance company if we know off the bat they're not gonna pass it. This is something that they're gonna go through and look at, and you have to be really honest because, of course, if you're not and they find something, you're either gonna be declined right away, or if you get approved, they're gonna do a look back, and you're gonna get declined and have no insurance. I mean, that's just not the place to be in. You gotta be ethical here. I mean, ideally, you wanna be able to be open about your health and whatnot, but some people are a little close enough about that.

So, knowing that your first choice, your first decision of what you wanna do when you turn 65 or when you're first enrolling in Medicare, is a really important decision. Because you might not be able to switch back out of it.

What About A Younger Person That Qualifies For Medicare?

Genevieve: Does all this information stand for, let's say, somebody that's much younger, not retirement age, someone in their thirties who's had something like a brain aneurysm or a significant stroke where they now aren't able to work, and they qualify for Medicare.

Dana: Great question. Medicare under 65 is for medical disability. And there are a couple of other medical reasons that it could qualify someone for Medicare. It depends on the state, but typically it's a Medicare Advantage plan because purchasing a supplement plan under the disability is really expensive.

Typically you see people that are on Medicare under 65 with Advantage Plans, and it’s not totally different. I mean, it's the same program. So to speak. But just then, when they turn 65, they actually get that free pass to join a supplement plan with no medical underwriting.

So, if someone is on an Advantage plan because, again, it varies by state, but a lot of times, they're just astronomically expensive for that supplement plan. They can, when they turn 65, have that opportunity just like anyone else who turned 65. Where there are no questions asked, and they can get on a full coverage supplement plan.

Genevieve: Yeah, I have several clients that are under 65 that qualify for Medicare. Good to know.

Okay, so the annual enrollment period. Anything else other than October 15 through December 7th? What else do people need?

Dana: Yes. So, like I said, a few times, the one time of year that you can make a change to your prescription drug plan, this is where you can make some changes in Medicare. You can enroll, change or disenroll in Medicare.

Also, there are time periods when you're supposed to enroll in Medicare and when you're supposed to enroll in a prescription drug plan. Some people miss that window to enroll, let's say, in the prescription drug plan. So this is then the opportunity for them to enroll if it might be for the first time in that prescription drug plan.

What we're gonna start seeing is a lot of advertisements on TV and on the radio. And the advertisements are all typically 99.9% Medicare advantage. And the Center for Medicare and Medicaid Services, CMS, has really tried to crack down. Last year, they really tried to crack down on some of these advertisements, and we haven't seen it really make such a dent.

And what they wanted to crack down on was the fact that these advertisements come out. They make blanket statements that make it sound like this program, Medicare Advantage, has a lot of free services, whether you can get money back from your Medicare part B, like free food delivery, free XYZ, all of this stuff.

But really, it's for a really small subset of people in one limited service area that may qualify for this, but instead, they make a blanket statement. They use a lot of images that make it look like it's from the federal government, and it confuses people. And what happened last year is a lot of people called. A lot of people switched out of their full coverage Medicare plan for this plan because they thought they were getting X, Y, and Z and bells and whistles.

And they weren't getting any of it. And then there are all these calls of complaints and disenrollment and people feeling like they were cheated almost. And we know it as agents, and we tell our clients, we tell our community, but they're still really confused because they see Joe Namath. You see these people on TV and especially late at night, but coming at you so hard that you start to wonder and believe it.

They'll get phone calls that say, ‘Hey, do you wanna save some money? Would you like to bundle your services?’ And that sounds great. And within a matter of five minutes of answering a couple of questions, they can switch you out of a full-coverage Medicare plan into one that has less coverage that you might not be able to get back.

So during AEP, the biggest tip I can tell anybody, and you said it at the beginning, you said, don't do Medicare alone. Do not make any changes without talking to your agent. And if you don't have an agent, as we said earlier, find one, ask your kids, and ask your colleagues. Ask your pharmacists, doctors, and financial planners.

I mean, ask around for a reputable agent. Ideally, I think an independent agent, again, cuz we talked about that. They can fully be able to give you multiple options with multiple carriers. But, just don't do anything alone. If you have questions, I'm happy to answer any questions. Does this look right?

I've had people call me and ask me about their parent's plans. “I'm worried, you know, my parents are 80, and I don't know exactly what they're on, and I just wanna make sure that they have coverage so we can look at plans.” We can find out just what they're on and what they may or may not be eligible for.

This is a time to do it during AEP. If you wait until after AEP is over, you're stuck for the rest of the year. The thing about it is it's from October 15th to December 7th, and it is the busiest time of year for Medicare agents, social security offices, and insurance companies. They all get really, really, really bogged down.

So you have to anticipate those delays. And you don't wanna wait until the last minute. And so that's the biggest piece of advice, too. Do it at the very latest, towards the end of October. Meet with someone. I say get everything done if you can by Thanksgiving. And then you just have your holidays and whatnot, and you can make sure that all of your ducks are in order, not waiting until the last minute.

There are 60 million people on Medicare, and the Medicare website often crashes during this time because everyone is on it. So you just wanna give yourself time. Yeah, you wanna give yourself time. During AEP, for those beneficiaries who are on original Medicare and a supplement, nothing changes to the supplement plan, again, because they're standardized.

So it's not about that. It's not about the supplement plan, and it is about the prescription drug plan. And they change dramatically. So actually, if someone is on a prescription drug plan or on a Medicare Advantage plan, they should have gotten an annual notice of change in the mail last month in September.

This would be a document that shows the summary of the changes happening from this year to next year if they stay on that plan. So, if they stay on their Advantage plan, here's the change of premium, and here's the coverage change. Doctors might fall out of network, so the doctors that they were seeing may no longer be in their network, which is a terrible thing for people.

Like you have a relationship with your doctor, and then he changes the network, and if you don't know and switch to a plan where he's part of a network. That could be a rude awakening, and that's really difficult, too, I mean, you have a relationship with doctors, and you wanna keep them. So, those are some of the things that you might see.

And with the prescription drug plan, the same thing. There might be a change. I talked about the formulary. There might be a change in the list of medications that are covered. There might be a change in the premium. So we are seeing some prescription drug plans going from a $20 premium to $70. That’s a lot of money in one month.

Those are the types of things that we will look over and find other prescription drug plans that still suit the client’s needs in terms of what they cover in their medications but might be at a lower cost. But if you do nothing, you auto-renew if you don't work with someone.

If you don't look at your annual notice of a change if you recognize and do a little research to find out what may or may not change, and you just stay with your plan and don't realize, oh, the prescription drug plan's going up X amount of dollars, $50 a month, then you're stuck with it, and that's a lot of money. And worse off, it could be that your doctors are no longer on the plan, or your medication is not covered.

Here are some of the big tips: Find an agent. Talk it through with an agent. Don't go it alone, for sure. And don't wait until that last week because it could just get really messy.

Genevieve: I just wanna touch on if you do nothing, you are making a choice. I mean, I hate to say it, but I had some recent personal experience.

Doing nothing is a choice. You are making a choice to put your head in the sand or not deal with it when you can work with an independent Medicare agent that can give you the education and the resources and help you formulate the right decision. How would somebody Google? How would they find someone like you if they wanted to work with someone in their state?

I want everybody to call you. I want your phone to explode, and you've gotta hire people to take all the phone messages and help you. But with that not happening, if someone is in another state, how do they find an agent like yourself? What do they search for?

Dana: That's a really good question, and I wish I had a better answer for you.

First, I'd say you can search for me, which is MedicareDana.com. I am licensed nationwide. I will say I'm not in every single state right now, but I'm in a lot of them, and I have a network of people that, if I am not licensed in that state, I can provide a handoff to someone that I know will take care of whoever calls me.

With that said, I think that referrals are so important. If someone does not know whom to call, I would say find me, and I will find someone in my network. I participate in networks that are qualified. National Association of Health Underwriters, NAHU, is a very large organization nationwide that is specific to insurance, and it keeps up on regulations and keeps up on basically everything that you need, like frontline lobbying for Congress so that when there are changes made, we’re on the frontline. But within that, we've got a really powerful network of agents that offer that same quality and integrity to their clients. And this is all over the state.

So I can find someone for anybody in a state that I know at least they're gonna do good work for. With that said, you can search for ‘Medicare agent.’ The problem, unfortunately, which is why I said I wish I had a better answer for you, is that the market is so saturated it's really hard to be able to tell who's an integral agent and who's not.

And if you don't have someone passing a referral to you or saying it's hard. While I don't want anyone to be fear-based, I do want people to be cautious because the senior population is such a targeted and scammed population. And you know, if you just call someone, you can ask all of the right questions, and the agent might answer them, but that doesn't mean that they're actually true.

I hate to say that, but you know an agent that doesn't really follow up with their clients isn't gonna tell a client that. They're gonna say, ‘of course, I keep in touch with you. And, of course, you can call me anytime. You just don't totally know what you're gonna get with that. So I think that obviously a website with reviews and things like that, but even at that, Genevieve, I mean, it's so easy for people to just make that up.

I would really say find someone who's worked with someone or knows someone or NAHU. Like someone who's involved in a more national association that pays dues, and there's a lot of integrity behind it. And, you know, insurance is regulated just like anything else. So there's continuing education for them and all of that.

But I would say call me, email me, and we can find someone in any state that someone's looking for. And there are a lot of really goofy situations that happen as well. So, we're like a think tank, and I'm part of some really wonderful organizations and just industry people that have been around for a while. We do lobby congress, and we've got some powerful people that if there are some really interesting things that happen, we can get the right people and escalate where it needs to be.

Social Security makes mistakes. And when they make mistakes, it's the person, the senior, that can have their Medicare turned off. I just had it happen where Social Security made a mistake, and someone's Medicare got basically turned off. They got disenrolled, and so they didn't have coverage because Social Security made a mistake, and now Social Security is trying to fix it on the back end.

But this person is still uncovered. They’re uninsured right now because they haven't fixed that mistake. It's not like social security is losing sleep over the mistake they made for this person who is losing sleep over the fact that if something happens tomorrow, they don't have insurance.

So we deal with so many interesting situations and having a wonderful kind of think tank, like I said, of people where we can bounce things off of who's been in the industry for a while, or there are new people coming through that are really helpful.

So I guess I would say to your listeners if you're in a situation that feels like something went wrong or calling Social Security and no one's giving you the right answer, and you're getting turned around in the circle. We could also help. And it's important. We're doing a lot with Congress, and we're doing a lot with our elected officials to bring them in because the seniors are really getting the short end of the stick when things like this happen. In order to make a change and in order to lobby for change, we have to be aware, and we're only aware if we hear stories from clients.

We can hear those stories, and then we can bring them to our elected officials, our lobbyists who do meet with CMS (Center for Medicare Medicaid Services). We have people that are meeting with them each year when they're coming out with the new guidelines. There are great resources, by the way, on medicare.gov.

They're a little bit convoluted to find, but they are there. I have a lot of them on my website, medicaredana.com as well. Because it's sometimes too convoluted on medicare.gov, and so it's easier to kind of pull them out. But, part of me and part of the organization that I'm on as well is that we have someone that sits with CMS to go over Medicare’s new guidelines and the changes and really be the customer’s voice because we're the boots on the street, right?

They don't really always know from the top down. So in order to get your stories or goofy things that are happening to the people that can potentially actually make the change, we have to hear about them.

National Association Of Health Underwriters

Genevieve: A couple of things. Go back and tell me the name of your association.

Dana: It's the National Association of Health Underwriter, NAHU.

Genevieve: Okay. I'm taking lots of notes, folks. I’ve got four pages. I like it. I'm gonna make sure that in the transcription, I put headings, so if you're looking for something specific that you heard Dana say, you should be able to look. You should be able to scan through the transcript and find it.

Pay Attention To The Squishy Feeling In Your Gut; Pay Attention To Any Flags; Don't Make Rash Decisions

Genevieve: And I'm gonna link to a bunch of your blogs. Dana, you've got so much great information on there. And then the last thing I want, I mean, we can still keep going, but I just wanna point out to the adults and the seniors that might be hearing this podcast, if you get a squishy feeling, if your flags are going off, just because the person comes across as nice, listen to your gut. Don't sign up. Just say thank you for the information. I will get back to you or call me tomorrow. Just don't make a decision at that time. Follow your instinct. Follow your gut, and don't sign over your medicare. If you are thinking there's any doubt, get someone to help you.

Dana: Yeah, a hundred percent.

We gotta look out for each other. It's the biggest thing, you know, when people are raising kids, they say it takes a village. And I think for everything, it really does. And we gotta lean on each other and look out for each other just like we would if someone came into a neighborhood and was robbing people's homes. There are crimes happening.

I mean, in the same vein, we have to look out for each other. There are a lot of real crimes that are happening to our seniors that are just more invisible, and we can't see them as much. And so we have to keep looking out for them and looking out with them and protecting each other.

Genevieve: What else do we need to cover, Dana? I think that we may look back at this and think, Oh, I forgot. Well, if that's the case, then we'll just do another one.

Dana: Yes. I think we covered a lot for this one. I loved your advice that if you got a weird feeling or just if you have questions, ASK.

I have a lot of videos on my website that covers all different kinds of areas, such as if you're working past 65, how to enroll yourself in a prescription drug plan, how to understand medicare.gov, and different rules. Utilize those resources.

There are different seminars and workshops and things like that. So education is just really the most powerful thing to be able to make an informed decision.

Work With Your Agent And Get Your AEP Done Before Turkey Day To Avoid The Rush When Agents Are At Their Busiest Time

Genevieve: Informed. And if you're squishy about it, that's my new word today. I like that word.

Don't commit. Then sleep on it. Just like you wouldn't buy a car if you had your doubts about it. Don't do it. It doesn't matter what they say. If you know your enrollment period, you've got ‘till December 7th, although we heard you say, Dana, don't wait. Get it done. Get it done before Turkey day. I think that's the other message, but you don't have to make a decision on the spot.

You should not be pressured. This is too important for your well-being and your financial security, and your mental health. I can't even imagine how stressful it would be if you found out you got on some plan that you had no intention of getting onto.

Dana: Yeah, and I think the last thing I would say is that this is a federal program, and even though Advantage prescription drug plans are not standardized, they're still part of a federal kind of umbrella in the sense of they're not standardized, but part of this program. Every agent should be telling you the same thing and backing it up with medicare.gov. If a client says, can you send me the link? I can send them the link to where this information is for them to find it.

If you are talking to three agents and they are telling you three different things, either all of them are wrong or two of them are. So that's something to be also cognizant of.

Genevieve: Great. Ask for the evidence. Yes, Dana. Thank you. I learned a lot. I probably thought I knew half of what you were going to talk about, but I didn't know the half of it, so I’m really grateful to you and your time and getting the message out.

And I'll do my best to get the show notes up and running, so it's easy to find the information that people are looking for. And then they will know how to reach you.

Dana: Perfect. Well, thank you for the opportunity. I'm so grateful, as I said at the beginning, to be part of you and your network and just support our communities and provide really valuable and honest information.

Awesome. Have an excellent evening.

Thank you. You too.

Categories: professionals to know, resources for seniors