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November 16, 2024 • 17 mins
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Episode Transcript

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Speaker 1 (00:00):
Good morning, and welcome to our show. This is Rob Kin.
Happy to be here with you today. Lindsey and ken
Lee Washington are unable to be with us, but I
wanted to go over as most of you know that
listen to the show for you know, a long time.
My main focus of businesses with seniors and their Medicare.

(00:23):
That is both Medicare supplements, Medicare drug programs, and Medicare
advantage programs. And if you've heard my show, you know
recently in the past, I was quite concerned before October
fifteenth that, you know, everyone need to make sure that
they run their drug program because of the Inflation Reduction
Act takes effect for twenty twenty five, and you know,

(00:47):
before the fifteenth, before I could actually run some drugs
and stuff, I was really concerned about how many plans
were getting pulled. Medicare advantage programs have been pulled out
of the market, some of the drug programs, etc. Et cetera.
I didn't know if there would be a good, low
cost version available for folks that just had you know,

(01:07):
maybe a few minor medications, mostly Tier one tier twos,
which fortunately I've learned since being able to run programs
for folks this year that yes, there are still some
decent programs, but the key is with the Inflation Reduction Act.
What it says for twenty twenty five is that a
senior will pay no more than two thousand dollars total

(01:30):
medication costs as long as and here's the key, long
as all your drugs are on the proper formulary. Not
all PDP or Medicare advantage programs have the same formulary.
So it's very important to run that. I've been again

(01:51):
doing multiple appointments, and after two weeks, I just wanted
to share with you some of the things that I've seen,
some of the ins and out. So every meeting that
I went to with the Medicare advantage companies, whether it
was at Humana, United Healthcare, Blue Cross, you know, et cetera,
et cetera, they all said because of this Inflation Reduction Act.

(02:12):
So in twenty twenty five it says, you know, you
won't pay more than two thousand if it's on the
proper formulary, and twenty twenty four this year you could
have paid eight thousand. Again it was subject to donut hole,
et cetera, et cetera, and all that goes away next year,
but the insurance company or the Medicare advantage, like for

(02:33):
all these Medicare advantage programs, they're the ones that the
insurance company has to cover that six thousand. So basically,
what has happened is a lot of what used to be,
oh I call them the goodie package, the dental division,
the hearing, the over the counter products, et cetera. Goodies
that they were given. You used to be you know,

(02:54):
some had much better goodies than other and so forth. Well,
they've all kind of had to pull back and truly
focus on just the medical benefits first and then kind
of with what's left over. Now again, they still do
have dental, vision, hearing, but a lot of those things
have pulled back. For example, there were some companies that
had one hundred and five or one hundred and ten

(03:15):
dollars per quarter over the counter products you could receive. Well,
that's getting pulled back. They might get forty five, forty
forty five fifty dollars over the counter. Their dental might
have been two thousand last year might go to twelve hundred.
I'm going to talk about one of the programs, Medicare Advantage,
and what they had to do with their dental that's
going to make the big impact this year too. Here

(03:37):
in a minute, but want to get the focus through.
So because of that, a lot of the benefits on
a Medicare advantage or the goodies, not the overall benefits,
have been reduced. Again, it's still a good way to
manage your Medicare. Also in the drug programs again there
were some that were pulled out on the PDPs that
have pulled out a lot of them that maybe didn't

(03:59):
have deductible last year, We'll have a deductible this year.
So when I'm running these numbers, the one kind of
catch twenty two for the one year is that again
the way that worked in twenty twenty four was you
might have lower copays during the first part of the year,
but then you get into the donut hole and the
payments went up well. In twenty twenty five because they're

(04:22):
adding these deductibles and so forth, the bigger payments are
going to be at the front load. So in January,
the first time you fill these medications, that'll be when
you get hit with the you know, the bigger copays,
and then potentially those will go down and may even
turn into zero later in the year, so kind of
reversed of what it was this year. But again, once

(04:45):
we get used to that, then it'll be a little
more consistent. And I don't like the fact that they
call it twenty or two thousand max out of pocket
for the year, because I guess it is a max
that you would pay out of your pocket. But some
of these more expensive medications you get credit for more
than what you actually pay out of your pocket. So

(05:05):
sometimes I've seen it stop it, oh sixteen or seventeen
hundred dollars max, that is the max, and then they
quit having to make payment. So again, it is very important,
especially if you have a Tier three higher or medication
that you go you know somewhere you either do it
yourself or you know, schedule an appointment and I'll help

(05:26):
you do it. But you're going to have to run
that drug list whether you're on Medicare advantage or Medicare supplement.
So I'll give you examples here in a little bit,
but of some of the things that we've gone through. Again,
all the meetings I went to, they basically said, hey,
we're focusing on the on the core medical and then
just pulling back on some of the goodies stuff. So

(05:49):
one of the people I had come in that had
a simple, you know, drug print. He has a Medicare
supplement once again not really doing anything with that. This
year they go up a little bit because you get older.
Every year they go up a little bit. But that's fine.
That's the medical And then for the drugs. I ran
his drug through the program. We were able to save

(06:11):
him a total of nineteen hundred dollars a year by
making sure that he had a the right program, but
not only the right program. He was currently filling his
drugs at costco, and we found that utilizing a different
preferred pharmacy on the new program saved him additional four
hundred so his total savings had he not come in

(06:33):
and we made the changes for him, he saved nineteen
hundred dollars for twenty twenty five by again just simply
making the change on the Medicare advantage side. Again, a
lot of the goodies have been pulled back, so like
the ETNA, the United the Blue costs, a lot of
them are a little more in line with one another

(06:56):
where they're very kind of comparable. Now, one of the
things of my companies that used to have kind of
an advantage, and a lot of my customers went to
them because for their dental and again this is key folks,
for their dental. It was if the dentist wasn't in
the network, that was okay because if he would he

(07:17):
or she would build ETNA out of courtesy, they would
pay them directly and they got full use of their benefits.
And even if the dentists wouldn't and they weren't in
the network, the customer could pay get reimbursed, so seniors
didn't have to worry about changing a dentist. So that
was nice. Well, in twenty twenty five, if you're on

(07:38):
one of the ETNA Medicare advantage programs, please be aware
that if you go to a doctor that or a
dentist that's not in the network, you'll pay a fifty
percent cope. My concern for that is kind of twofold.
A when they send you your annual notice a change,
it's kind of hard to figure that out, although you

(07:59):
should see it. It's it's gritten there and it says that,
but it's the fact that again, if you don't make
a change and you just go, you're going to pay
that fifty percent and the fact that because you know,
for so many years has just paid these dentists. I
called the dentist for one of my customers up in

(08:21):
Aldridge and was letting them know that, Hey, are you
guys going to be a network for twenty twenty five
And they said, oh, no, no, but you know ATNA
pays is just fine, And I said, no, no, no,
I understand ETHNA pays. Just find this year. However, next
year it's going to be network only, and your customers
are going to be pretty upset if they come in

(08:41):
and find out they have to pay fifty percent, and
you know you didn't let them know that. So again, folks,
it's very important to get with your advisor, you know,
independent agent, whomever you're getting that your product, your Medicare
advantage product through if you're on that, to just review
all the changes. A lot of the again, the benefit
fer being pulled back so they're dental again. Is now

(09:03):
a network based dental, which is fine, but pretty much
all of them are dental based. So again you got
to compare the pluses and minuses because they're a lot
closer together. Again, they used to have kind of the
best overall goodie package and again the dental, you could
go anywhere, So a lot of people picked that plant.
Also in twenty twenty four, for my snowbirds, they had

(09:27):
a plan through Health Partner's Unity Point. It was a
great one for snowbirds because it was the same in
and out of network, so when you're down in Florida,
Arizona or wherever, you could pretty much see anyone and
you'd have the same copays and the same max out
of pocket. And it had a decent goodie program, you
know what, the dental and the vision and so forth.

(09:48):
But because of this inflationment re Dark Snack, they did
pull out, so that's no longer available. So if you
had Health Partner's Unity Point Medicare Advantage program, you need
to make sure you get in before this number seven,
then get signed up for a new program because that
one is no longer available. Now. With that being said,
also those people with a program that's no longer available,

(10:09):
whether it be the Health Partners or one of they
out no programs, or any program that's not being operating
again next year, that that does give you a special
election period if you want to switch over to a supplement.
There's no health questions for you. So that's just a
piece of information you want to be aware of. So
again you could go ahead and you know, do a

(10:31):
supplement or look at these other Medicare advantage programs. Now,
one of the other issues that I bumped into recently
with one of my customers is that they have certain
drugs for their there some machine, you know that they
have to utilize their nebulizer machine, and it's three different

(10:53):
expensive drugs or medical or you know, things that they
have to get through the pharmacy. They're very very spensive
solutions and whatnot. But two of the three weren't on
anybody's formulary for twenty twenty five. So again that those
are going to take a little bit more work and
making sure that we can get some pre approvals get

(11:13):
them on the formulary. We'll have to ask for a
formula exception for twenty twenty five to see otherwise they're
looking at you know, instead of two thousand dollars, I mean,
the cheapest thing was like twenty thousand dollars. So again,
a little bit of more work we got to get
adjusted to this new program. Very very important that you

(11:34):
get out and get those done. Like I said, I
was able to save a drug program person, you know,
nineteen hundred dollars by making sure they were on the
right program, and then I was able to save where again,
we're working on that one customer to get some pre
approvals so that they can keep it under that two
thousand dollars. Now, again, I'm not trying to push the

(11:56):
panic button here. A lot of the people people that
have been coming in that have a program that they
like and they don't really have any like Tier three
or higher drugs, you know, they're tending to stay with
their same Medicare advantage program. For people that need a
drug program, again, if they don't have many medications, there

(12:20):
is a zero premium program available both on the Iowa
and Illinois side. So again, if they're all just maybe
tier one and Tier two, take a look at that,
because again, you know, if you're paying sixteen hundred bucks
a month in premium for your current drug program, which
might have been the best one for last year, you know,
that's you know, almost two hundred bucks. That's two hundred

(12:41):
bucks for the year difference just in the premium alone.
So again, folks, if you want to get the best
over value, make sure you've got the best thing going
and you're not going to get any big surprises. You've
got to get out there, make sure that you go
ahead and get you know, with your advisor and get
those things taken care of. I've had number of people

(13:03):
that had maybe one expensive medication that are having to
switch from you know, one company to another. You know,
maybe they were on that and that they got to
go to Blue Cross. Again, you need to take a look.
Is Mayo important. I've had one customer that this year
in twenty twenty four developed cancer. They were diagnosed with

(13:24):
a cancer and they assumed that it was going to
be good at Mayo, which the ATNA is not in
the Mayo network. Some of the other ones are. So
again you need to really oh sorry, train's going by.
You just need to be aware of, you know, the
limitations of your plan again, whether like I said, the

(13:47):
dental is whether the dental is a network based program
or whether it's reimbursable. Like I said, pretty much all
of them that I'm aware of this year on the
Iowa side, for sure, are only network based and you
need to make sure you're dentist in the network to
get the best benefit. Again, they don't have to be
like those customers. You can pay fifty percent. Again that

(14:10):
it's better than one hundred percent, I guess. So again,
there are some choices that are gonna have to be made.
And you know, I know, like for myself, I'm booked
two and a half three weeks out already just with
all the customers needed to come in. So this is
the year if you've if you haven't been at at
you know, haven't if you haven't compared your stuff in

(14:34):
the last few years this year, please please please get out,
have that taken care of. It's just like the Homon
Audo you know, Lindsay and Whitney here they do the
hom and Audo stuff for us. And we're getting calls
you know, all the time where we're gaining a lot
of new customers because this year especially, the increases have
been you know, incredible. I mean the thirty forty, fifty

(14:56):
sixty percent increases on Homon Auto. And again you know
that's that's due to a lot of this kind of
weather things that we've had going on, inflation in general,
et cetera, et cetera. But you know, if you see
like those big increases, then all of a sudden. Yeah,

(15:16):
you're ready to go get a quote once you get
that letter. So again I'm trying to give you the
warning same what's your stuff. You should have gotten an
annual notice of change that would have been sent out
to you about the first part of October. Make sure
you're going through that and reading it, especially if you're
like on a Medicare advantage or just your regular party program,

(15:38):
because it will tell you what's changing in the program. Again,
I only booked out, you know, a few weeks in advance.
I still have plenty of openings, so if you would
like to come in for a review, please call sooner
rather than later, just to get you know, a spot reserved,
because the time is going to fly by. We got
the holidays coming up and all of that. We want
to get everything done before December seventh. This is the

(16:02):
first year I've actually had well, probably half a dozen
people so far that you know, once we look at everything,
they really still aren't sure what to do. But again,
now they've got time to finish doing a little bit
of research, comparisons, talking with other folks, and you know,
getting the right plan again. That's all about making sure

(16:23):
we have the right plan in place, so again, Medicare's
annual roma here he goes from October first to December seventh.
We have until December seventh to get you know, these
things turned in. I want to make sure that again,
all of the folks out there listening, seniors you know,
that are on Medicare, get the best value for your dollar.

(16:46):
And that's what City's Insurance Group's all about. If you
want to give us a call, if you'd like to
set an appointment, or if you need a home and
auto quote, life insurance quote, or again Medicare information, please
give us a call here at Cities Insurance Group five
six three three five nine oh eight five four. That's
about all I can say. You know, I hope you

(17:08):
guys are out there. I hope you enjoyed the good
weather while it lasted. I hope that we're not in for,
you know, a really bad winter, because it really extended
into the fall here. But yeah, give us a call
five six th eighty three five nine to eight five four.
Have a great weekend and we'll talk to you again
soon
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