May 29, 2025 • 40 mins
As the debate over healthcare rages in Washington, seniors are left trying to navigate a complex maze of insurance plans and prescription coverage. In this episode, Jesse chops it up with Leo Stella of Stella Health Insurance Agency, pulling back the curtain on Medicare and its real impact on your life. From hidden costs to essential benefits, learn how you can avoid common mistakes and make informed decisions that protect your health—and your bank account.
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Episode Transcript
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(00:00):
today we're diving into somethingthat affects millions of Americans,
but doesn't always get the spotlight.
It deserves healthcare accessfor seniors and the quiet complex
battleground known as Medicare.
While Washington debates budgets andheadlines swirl about proposed cuts,
(00:23):
everyday people, especially olderadults, are left trying to make sense
of a labor of insurance options,prescription plans and shifting policies.
And for many, the stakes aren'tjust financial, they're personal.
Our guest today understandsthis better than most.
(00:47):
Leo Stella is not only a veteran inthe healthcare and insurance space.
He's the founder of StellaHealth Insurance Agency.
An organization built around a radicalidea that navigating Medicare should
be clear human and actually helpful.
(01:07):
Imagine that in these days, and inthis conversation we'll talk about
how Leo's agency is meeting peoplewhere they are with personalized
care, community outreach, and a deepunderstanding of the systems that
too often fail, the most vulnerable.
We'll also unpack a little bit thelatest changes coming out of dc,
(01:32):
what they mean for seniors and whyaccessible healthcare isn't just a
policy issue, it's a human right.
With all of this going on, I knewLeo would be the right person to
talk to, and he joins me right now.
Hello, Mr. Leo Stella.
(01:54):
Hi, brother Jesse.
How are you?
I'm blessed, nevertheless,in spite of all the rest,
happy Memorial Day, by
the way.
Awesome.
Yeah.
Same to you.
Same to you.
Thank you.
And everybody out there.
Just one correction I like to make.
I am please not the founderof Stella Health Insurance.
Oh, okay.
I promoted you.
Yeah.
Even though, which right.
(02:15):
So actually the founder of StellaHealth Insurance in the name of
the agency does have my last name.
So the founder is my cousin, Eric Stella.
Oh, okay.
And Yes, and he actually founded theagency about two years before I joined.
So we're talking about possiblyaround 2011, and I joined in 2013.
Okay cool.
That's a good good to know.
(02:37):
We'll have to have himon one of these days
for sure.
I'll pass the word along.
Cool.
Cool, cool.
But for now, we've gotthe one and only Leo.
Yes, sir. Yes, sir.
With that.
Go ahead.
Go ahead.
No, you go ahead.
Go ahead.
No, I was gonna say, to tell you a littlebackground about our agency and what
(02:58):
we're all about, please, at Stella HealthInsurance we're an independent insurance
agency focusing on providing clients witha personal approach to healthcare choices.
Our aim is to educate our clients onhealthcare choices with an expert in the
comfort of their home, their, our office.
And most of all, very importanthere, our services are at no cost.
What Now, of course, that, that mightbe something down the road on the line
(03:22):
of questioning or whatever, but thatgives me pause right there and should or
probably get a hold of a lot of people.
Pause free.
No, excuse me.
No cost.
No cost.
Correct.
And it's funny because there are certainterminology that we're allowed to use.
There's, there's an organization a federalorganization called CMS, which I refer
(03:43):
to as the FBI for Medicare, and theyregulate Medicare and and basically are
there to protect all the beneficiaries.
Okay.
They're like the Medicare policeand they watch everything we do.
So that medic, Medicare beneficiaries
are protected.
Are they independent of thefederal government, or are they
a subsidiary or arm of somethingelse within the federal government?
(04:06):
No, it's within the federal government.
They're connected to to Social
Security and Medicare itself.
So they didn't get affected by Doge,
by what?
I'm sorry?
Doge.
DOGE?
No.
Yeah.
I don't think so.
No.
Yeah.
'Cause I know a lot of.
Or many agencies, watchdog agencies orwhatever in particular, one thing that
(04:29):
comes to mind, the civil rights divisionof the Department of Defense, for instance
that's been, gutted out and the igs werefired and other areas there which were in
place as watchdog type of, organizationswithin the federal government.
It's good to know that they're still therebecause I would guess they're a legacy
(04:53):
organization and that they've been there,they're career, healthcare, professionals.
Would that be a fair statement?
I believe so, yes.
Okay.
Yeah.
That's good that they're in place,for, especially for the consumer.
Of course.
Of course.
Like I said, they're the watch dogs.
They.
(05:13):
They watch everything we do as agentsso that we don't take advantage.
There's a lot of unscrupuloussalespeople out there.
And their practicesaren't always the best.
To say the least,
to protect the Medicarepopulation, our seniors.
Correct.
Hey can you along those lines, can youshare a story that highlights how your
agency has made a tangible differencein a client's healthcare journey?
(05:40):
There's so many stories out there, andwe focus on, basically educating Medicare
beneficiaries are mostly seniors.
Don't necessarily need to be a seniorto be a Medicare recipient, but yeah.
So we're out there to basically educatethem so they can make the best choice
when it comes to their healthcare options.
A lot of people tend to go by whattheir friends say or what they're being
(06:03):
recommended by hr if they're, planningto retire at a particular moment and
they just trust individuals insteadof getting general information just
really in depth educated info so thatyou can actually make the best choice,
the wisest choice for your healthcareand your pocket as well, because you
might actually end up paying moneythat you don't need to be paying.
(06:24):
So now they'll find thisout through consultation.
What's the process?
How would this process startfor the the average individual?
I don't know.
You said that they don't haveto be seniors or whatever.
So for the average individual howwould they start this process?
How would they know about your agency?
(06:46):
The agency, it's justlike any other agency.
We're being marketed outthere on social media.
You might see some ads on Facebook,Instagram, and I have, and mailer, and
basically, the way Medicare works isonce you're reaching the age of 65 for
most people the window of enrollment,the initial period of enrollment for
(07:08):
Medicare, it's a seven month window.
So it starts with three monthsprior to your 65th, 13 month.
And it goes all the way past threemonths past your 65th, 13 months.
So you got seven months to enroll intoMedicare, and that's original Medicare,
which is composed of four parts,but we'll get into that in a minute.
Okay.
So during those seven months, you canactually do your research, your homework,
(07:30):
and see what the best option is for you.
You start, you will startgetting bombarded with phone
calls and mailers usually.
About the time you turn 64.
'cause they want you tostart preparing for it.
So that's when you start digging aroundand see what your best options are.
And my recommendation is to speak toan expert instead of just going on your
own or a recommendation from a family,member or or a coworker per se, right?
(07:53):
You, they whatever fits them and itexcluding them, might not necessarily
be the best option for you.
Okay.
So if you'd we can go into a brief,like Medicare 1 0 1 and go step by
step to, so that the audience can know.
I think works.
I think that would be good becauseI mean there is, just a whole lot of
(08:13):
things going on right now and, maybewe'll touch on some of them down
the, in a few minutes here or so.
But and you mentionedsomething that was, new to me.
You said that that this was theold or original Medicare opposed
to I guess the new Medicare?
So I know a lot of people would benefitfrom, just knowing more about it because
(08:40):
a lot of the information that's comingout of DC I guess for better or for worse
or whatever we don't really know what tobelieve, because there's a lot of people,
I'll just be frank, a lot of people lying,and then you've got, these other agencies
was that Medicare Plus or Advantage andall these other organizations that are
(09:03):
popping up claiming to bridge the gapand wanting to help you out or whatever.
But it just seems likeit's another racket there.
So if you could take usthrough that would be great.
Sure.
Just to clear one thing up rightoff the bat, Medicare, original
Medicare doesn't refer to an oldversion of Medicare versus a new one.
(09:26):
Original Medicare is actually whenyou when you only get Medicare
provided by the government.
So basically.
Who's eligible for Medicare, peoplethat are turning 65 or older.
You can also be eligible forMedicare if you're under 65 if you
have a social security disability.
So if you're receiving SSDI, sosocial security disability benefits
(09:48):
for a minimum of 24 months and you'reunder 65, you can also be eligible
to receive Medicare benefits.
Okay?
Also, if you have an illness ofend stage renal disease or a LS
Lou Gehrig's disease, you're all atany age, you can also be eligible
for Medicare, and you must be a UScitizen or a per permanent resident
for at least five consecutive years.
(10:10):
This makes you eligible toreceive original Medicare.
Okay.
Now, original Medicare is composed offour parts, and those parts are parts A,
B, C, and D. And let me go through whateach one of those parts mean please.
So basically part A.It's hospital insurance.
(10:30):
It provides coverage for inpatienthospital care, skilled nursing facilities,
hospice care, and some limited homehealthcare among other services.
Part A is earned by having workeda minimum of 40 quarters or 10
years legally in the United States.
And you must have paidtaxes during those 10 years.
Okay.
That's given to you automatically if youhave those requirement requirements met.
(10:54):
Part B of Medicare is optional andit comes with a monthly premium.
That monthly premium tends to changefrom year to year, and there are
periods of time where the, the me, thepremium, the Part B premium stays pretty
steady, but for the past few years,it has changed and it has fluctuated.
Last year it was $174 and 70 cents.
(11:16):
This year for 2025, it went up to 180 5.
The coverage for Part B is doctorvisits and preventive services,
outpatient surgery, emergencycare and durable medical equipment
among some, a few other things.
Now, like I said MedicarePart B is optional.
(11:36):
The thing is that in order to qualifyfor Part C, which are Medicare
Advantage Plans, and these arethe plans that I mostly work with.
You need both parts A andB. So what does that mean?
So you pay you, you have PartA, you know you earned it.
By having worked those 10 years,you choose to activate Part B with
(11:57):
that monthly premium that makesyou eligible for Part C, which
are the Medicare Advantage plans.
These plans come with no monthly premiums,no deductibles, and the majority of
services are covered at a $0 copay,at least here in Southern California.
Copays and deductibles tend tochange from from state to state.
But for the area that I work,Southern California, that's
(12:20):
usually the way it works.
Okay.
Now, so I touched upon, part A, B,and C. Part D are prescription drugs.
So it's coverage for presfor prescription drugs.
Now these part C plans are all inclusive.
So basically you have a B, which areoriginal Medicare, and then by law
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you must enroll into a Part D plan.
Those plans, if you do a standaloneplan, usually come with a monthly
premium, and those premiums actuallyhave gone up this past year.
And it varies from carrier to carrier,but you can expect to pay maybe around
upwards of 15 and more for a monthlypremium if you get a prescription,
a standalone prescription drug plan.
(13:03):
Now going back to the Part C plans.
These Part C plans are all inclusive,so you get part everything.
That part A covers everything thatpart B covers, and then everything
that Part D covers all in one.
And like I said before, these plansdon't have any monthly premiums, no
deductibles, and the majority of medicalservices are covered at a $0 copay.
And since that Part D coverageis embedded, you don't have
(13:24):
to pay that premium for theprescription drug coverage.
Now, you said that you you arecompelled or we are compelled to
receive part D coverage by law.
How, can you expound on that alittle bit more as far as why
(13:45):
is it compulsory to do that?
What?
To be honest, I don't know theexact origin of why it's mandatory.
But it is the law.
If you choose not to activatepart D or part B, right?
And later on down the line, when yourhealth guard deteriorating or you find
the need for those types of coveragesif you have waited more than a year
(14:09):
from the moment you were originallyeligible, you could incur penalties.
Wow.
And and then Exactly.
And then you wanna try to avoidthose penalties by enrolling
into those coverages on time.
Now there, there are peoplethat can not necessarily get
away, but avoid those penalties.
And that's usually because they havehad, or continue to have passed the
(14:30):
age of 65 coverage through work.
So if they have coverage, medical coveragethrough work, that means that they
have a, an eligible or comparable plan.
That meets the requirements from thegovernment for you to have that coverage.
So if you've had, if you're 67, 68and you're still working and you have
coverage through work, that means thatyou're have, you have medical coverage
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and coverage for your medications, andyou're not subjected to those penalties.
Now the moment that coverage ends, oryou decide to cancel it, then you have
to worry about activating those policies,those coverages, so that you don't incur
those penalties a year from that point on.
Okay.
I understand.
I mentioned earlier that, that there wasa lot of things going on in dc what are
(15:15):
your thoughts about the recent Medicarepolicy, at least the proposed changes?
I know that the Senate still hasto take a crack at and everything.
The house is already approved the cuts.
And so I'm just wondering, how do they howmight they affect the average beneficiary?
(15:36):
You know what, we don't havemuch information on that.
It's just like a wholebunch of speculation.
We keep hearing that our presidentis trying to get rid of Medicare
altogether and this and that.
And to be honest, I haven'theard anything myself where
it's actually gonna take place.
And obviously, people will getscared and they feel that it's
gonna affect them negatively.
But as far as like actual changesthat happened before the end of 2024
(16:00):
that were gonna be implemented for2025, I can tell you, prescription
drug coverage was gonna change.
So this is part D of Medicare.
There was a reduction in the annualout-of-pocket cap for Part D. Right.
And and something we call the donut hole,which is the gap for Medicare changed.
So it got, it pretty much got eliminated.
So before, up to 2024 if you hit acertain amount in expenses through
(16:24):
your your prescription drug use,you would hit and enter a face
call the donut hole or the gap.
And that amount was about $5,000.
Let me look it up really quick.
But once you hit that donut hole,you basically started paying
(16:45):
here about 25% of yeah.
So the initial coveragelimit was 5,000 $5,030.
So once you hit that limit,you were gonna start paying 25%
of the cost of generic drugs.
And brand name drugs.
If you had expensive medications,you were definitely gonna go
up there and go there, right?
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So then your the cost of yourmedications was gonna go up,
your expenses were gonna go up.
If you reached the next phase, whichwas called the catastrophic stage,
and that was at $8,000 out of pocket,you your expenses would actually go
down and you would pay the lessercost of either 5% or the actual cost
(17:27):
of the medication, whatever, like thecopay that the plan would offer you.
So that's changed.
So now they changed it to where the,I guess there was only you would go
directly into the catastrophic stage.
So once you hit a $2,000 out of pocketlimit you in 2025, you go directly into
the cata, which means that at that pointyou don't pay anything for the remainder
(17:48):
of the years for your medications.
It's gotten better in favor ofthe beneficiaries, especially
those that have expensive drugs
Now, do you expect that to change
Or is that a part of the rumorsand propaganda that's going around?
That part right there would change andall of a sudden costs will go up and some
(18:11):
people will be even, kicked off the roll.
I hope not because as it is some of theother changes that were happening were
certain medications were being droppedby plasma and not being covered anymore.
So that wasn't a, such a good thing.
But in regards to the actual,out of pocket expenses.
I think it benefits all those chronicallyill, patients that have expensive drugs
(18:34):
because to tell you the truth in myexperience, when you run into healthy
Medicare beneficiaries and they'reonly using like generic drugs and you
only have like maybe a handful thatat most those medications tend to be
covered at a $0 copay with most plans.
So them hitting that donut hole orthe catastrophic stage is very rare.
(18:54):
So it's mainly help for those peoplethat have, chronic conditions,
that have expensive drugs.
And I hope it doesn't change, we don'tget news like that until we're getting
close to the annual enrollment period,which takes place between October 15th
and December 7th prior to that, we startgetting some trainings and we start
getting informed on the changes thatare happening for the upcoming year.
(19:16):
If you could share, you don't haveto share the exact, conversation or
whatever, but are you receiving a lotof calls and or emails or contacts from
beneficiaries or just people curiousabout what's going on with Medicare
as it relates to the changes thatare coming out of out of Washington?
(19:38):
No, not really, to be honest.
The average beneficiary just, isworried about not spending too much
money and having good coverage.
And these plans are great.
It's one of the good things aboutour agency that we're actually
like a brokerage company, right?
Where we contract with multipleplans, especially the big hitters like
UnitedHealthcare, blue Shield, blueCross, but we have options to offer.
(20:02):
So all these Medicare optionsand plans are not cookie cutter.
They're not necessarilytailored either, right?
So what we do is we do an analysis oftheir medical needs and we also do a cost
analysis of our, their medications tosee what plans you're gonna give them.
The best coverage.
At the lowest cost, basically.
And so they do the the potentialbeneficiary or the beneficiary,
(20:26):
they receive all of this helpfrom your agency at no cost.
Correct.
That's, that sounds like a whole lot
compensated.
Yeah.
No, and that's the thing.
Medicare can be overwhelming.
Yeah.
Like I said, once they turn, beforethey're gonna start getting all
these this correspondence, phonecalls, and it can be very confusing.
(20:47):
Or even those TV ads with with Mr.Football player and everything.
Sometimes people will get into trouble.
Exactly.
People will get into trouble becausethese are trusted figures, pop, yep.
People in the industry that, thatgain their trust and they'll make
that phone call and the person onthe other end doesn't necessarily
have their best interest in mind.
So they'll get them enrolled into a planwithout doing the proper background check,
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make, making sure that all their doctorsare in network, that their medications
are covered at the lowest cost.
They basically enroll them intoa plan just to make that dollar.
That's not what we're all about.
We dig deep, make sure that all theirdoctors are covered, that's the way they
want to go, and we'll recommend two tothree plans at most, which will give them
the best coverage at the lowest cost,basically, and save them some money.
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And like I said earlier,there are options.
Once you turn 65, you can go with originalMedicare, which is just A and B, or
just keep, a lot of people keep just a,because they've earned it and they don't
activate part B. But then later on downthe line, they might run into issues
because they need to activate Part Band then those penalties come into play.
The other option would be PartC, the Medicare Advantage plans.
(21:55):
The third option wouldbe Medicare supplements.
Now Medicare supplements theydifferentiate themselves from
Medicare Advantage plans inthat they're like a like PPOs.
Okay.
Because Medicare Advantageplans are HMO plans where you're
bound to a network of doctors.
Oh, okay.
Network.
You can't freely go to a special.
(22:16):
You have to get a referraland this and that.
And I know that, for a verylong time, HMOs have had a
bad rep, a bad connotation.
But in my experience, honestly, I can tellyou that the speediness of getting those
medical services depends on what medicalgroup you affiliate yourself with, right?
So we tend to work with medical groupsthat are, that expedite, referrals that
(22:38):
have high need and things of that sort.
So they tend to not take too longto get a referral authorized and
approved so that they can make theirappointment with the specialist.
Now, getting back to the Medicaresupplements give you the freedom to go
anywhere you want, but the catch is thatthese plans, unlike Medicare Advantage
plans, don't offer all the extras andthey come with a monthly premium, right?
(23:01):
Remember, so Medicare Advantage plans,no monthly premium, no deductible,
and the majority of services arecovered at zero Medicare supplements.
Come with a monthly premium, whichis based on your age and your zip
code, and they don't carry all theextras that Medicare Advantage plans
have, such as vision coverage, dentalcoverage hearing, and a whole bunch
of other perks like transportation,gym membership, and allowances for
(23:24):
over the counter drugs, groceries,and even utility bills, zip codes.
The other thing is go ahead Justin.
I'm sorry.
No.
That that that phrase just stuckin my head there that depending
on your zip code that woulddetermine your coverage as well.
Yeah.
It determines the monthly premium Yeah.
That you would have to pay.
(23:45):
Some areas of the county or the stateare more affluent than others, so
depending on your age and your zip code.
They determine the monthly premiumthat you would pay for a Medicare
supplement, and it's basicallyyou're paying for a luxury, right?
To have that freedom to, without havingto wait for a referral to get authorized.
That's the and I'm very familiar withthe PPO and HMO systems there working
(24:10):
in corporate America for many yearsI was always a PPO type of guy there.
Although as a service member, Idon't know what you would call that,
because, everything was, no costand free and usually got, the best,
that there was, on, on a particularbase that whatever particular
base you found yourself on there.
(24:31):
I've, I have tried the HMO route there.
But I must admit, I wasn't a big fanof reaching a particular threshold or
criteria or whatever to get a referral.
So I've been as they say, payingout the nose for years for PPO
so that I can go to where I want.
(24:52):
Plus, I, I've had the same doctorfor, many years, but that's just me.
I know that, that
was a question, that wasa question from me to you.
Did you try both systems, the PPOand HMO system with the same doctor?
Not with the same doctor becauseI was in different different
places at different times.
That's where the difference comes.
(25:12):
Like I said, if you have, itwould be a fair comparison.
If you could say that when you had theHMO with a particular doctor versus
the PPO with that same doctor, you weretreated differently and the quality
of your healthcare was different.
But with the doctors that Iwork with, they take both.
So the quality of medical care.
It's the same, it's only thespeediness of how quickly you can
(25:35):
see a specialist, for example.
And like I said, in most cases you canget an authorization, sometimes you can
even walk out of your appointment withan authorization approved in your hand.
That means that you can callright away and make an appointment
to see your specialist.
And depending on the specialist andavailability, that's how quickly
you can see that specialist.
Yeah.
And I know a lot of people, in fact ourmutual friend that would normally be
(25:58):
with me and one this we've got a coupleof different podcasts going on, but one
of the podcasts the Healthy, wealthyand Wise podcast would normally have a
person that's near and dear to both of us.
Dr. Choctaw.
Yes.
Now he.
He would swear by Kaiser, and I don't meanto name drop, on this episode or anything
(26:19):
like that, he had no problems with them.
And I think it's been a long time,but I think I had a bad experience
with him or whatever and I neverwent back or something like that.
And then I've heard other horrorstories, depending on which Kaiser
you went to and all of that.
But but yeah, he held them in high regardand I know a lot of other people hold that
(26:42):
particular organization in high regard.
Yeah.
I was gonna, chime in on that, thateverybody has a different experience.
It's like with every product, everyservice, some people are gonna
have a good experience, others aregonna have a terrible experience.
So it's like you can't really saythat one's better than the other.
It
comes to Kaiser us as brokers.
(27:04):
We're having, we haven't been allowedto, let's say, contract with them.
'cause otherwise we wouldn't, wewould need to have exclusivity.
So we wouldn't be able to sell other plansthat have different options to offer.
Okay.
So I know a couple of years ago therewas talk that Kaiser was finally
gonna open their doors for us brokersto be able to offer their services
and their Medicare plan as well.
(27:25):
Okay.
Along with the ones that we already do,
what happened,
but it still hasn't happened.
Oh.
So when I run into a Medicare beneficiarywho's been a long time Kaiser member, it's
usually a really almost impossible sale.
Yeah.
Yeah.
There, there's a lot of peoplereally connected to that
organization, very loyal to them.
And evidently for goodcause or good reason.
(27:50):
Now, Hey
Exactly.
And like I said, not everybody hasa pleasant experience with them.
I'd say about five, six years ago I wentto go see a client of mine, this older
lady and her son-in-law was sitting at thetable with us and he was a Kaiser patient.
So we began to talk and he told methis story that during the year he
(28:11):
had a surgery which he spent about,I think like somewhere between
200 and $400 for the surgery.
And then and medication costs.
He was spending about the same per year.
And I told him, let me do a quickcheck on your medications right now.
Let me run the cost and see whatit would cost you with a plan
like your mother-in-law has.
(28:33):
And so right off the bat I told himthe surgery itself would have cost
you zero if you would be in a planlike the one that your mother-in-law
has, and your medication costwould be reduced to $20 per year.
His eyes got wided open.
Mine just did too.
Considered changing, exactly.
At the time the benefits forKaiser's Medicare plan were
(28:54):
like, the copays were higher.
I don't, I'm not updatedon the cost right now.
They might be a lot more comparable now,but back then they had higher costs.
It was like almost like a no brainer.
I got 'em to switch.
I convinced them to switch.
I got that enrollment on the spot.
The only catch is that if they wantchange plans, since Kaiser doesn't take
(29:14):
any other, carriers like Blue Shield, anyother outside, companies, he would have to
have changed doctors and he agreed to it.
I imagine that as we progress throughlife and get to certain stages, we.
We do make certain changes, make certainadjustments that we've held on to perhaps
(29:35):
for years or whatever, but now it makesbetter sense to go a different direction.
It's always a good idea to testthe water somewhere else and see
if it is gonna benefit you or not.
There's always the option of going back.
So every time somebody hesitatesto let's say, for lack of a
better word, take my advice.
(29:56):
I always tell 'em, you can alwaysgo back, but give it a try.
Give it a try.
And if you feel that you're betteroff, then I did you a favor.
That's fair.
That's definitely fair.
Totally.
Now does Estella Healthcare InsuranceAgency you're involved with community
outreach to a degree, right?
Yes.
(30:16):
We periodically do Medicare one oh ones.
We'll set up seminars, we'll do shopsto talk about LIS, which is low income
subsidy, which is another name for thatis Extra Help, Medicare Extra Help.
So it helps reduce thecost of their medications.
And this is, you qualify ifyou're low income, obviously.
There's another program called QMB,which helps pay the monthly premiums
(30:40):
for premiums and deductibles forparts A and B. And we do outreach
like that for the community.
We also work with Medicarebeneficiaries who have Medi-Cal.
So these are called Meeds, right?
They have both Medicare and Medi-Cal.
These beneficiaries actually have aslightly different option of Medicare
plans where they actually get.
(31:01):
Additional coverage and those extraperks, those extra services that
these Medicare Advantage plans offer.
If they were to be just strictlyMedicare Medi-Cal recipients, they
would be missing out on a whole bunch ofother stuff that's out there for them.
I see.
Looking ahead, what are some of thekey challenges and opportunities
that you can foresee in thehealthcare insurance landscape?
(31:29):
What do you mean exactly?
Again, referring to the changesthat are coming down the pike
there, whether or not there were anychanges or not we've got, artificial
intelligence doing scannings andqualifications and things of that nature.
Just, other technology comingonline designed to either increase
(31:51):
mortality rates and or decreased cost.
There's just a number of thingsout there that would that will
affect, the healthcare insuranceend of the business there.
And I was just wondering what whatyour thoughts on any of that was
or what do you see down the road?
(32:11):
I'm hoping that, the cost forthe beneficiaries remains,
controlled and and low.
Like these these MedicareAdvantage plans are designed to do.
'Cause I would hate forseniors to start paying more.
The other thing that that I see happeningis a focus on preventive care, right?
As opposed to keeping beneficiarieswith their expensive medications.
(32:33):
Medications that sometimes may haveside effects and things like that.
There are medical groups that arefocusing on preventive care at keeping
these beneficiaries healthy so theycan have a better quality of life.
There's there's a new medical group that'sfocused on the approach of the Blue Zones.
I don't know if you'refamiliar with the Blue Zones.
No, I'm not.
(32:54):
The Blue Zones, there's a a documentaryon Netflix where there's five zones
around the world that have thehigher volume of Centurion people
that live past a hundred years old.
So they did some research wherethey're finding out their habits,
their lifestyle, and everything to seewhat's causing them to live longer.
(33:15):
And it's based on, a healthier lifestylein regards to diet, less stress.
There's a few of these that are likeold style villages where they're,
modern technology doesn't affect themas much as, the rest of the world.
And staying away from that alsocontributes to their long life.
And there's a few other elements,but if you get to watch that
(33:36):
documentary, it's pretty great.
Okay.
So this medical group it is connectedto that original documentary and
their approach is that, preventivecare having an input in regards to
beneficiaries having a longer lifespanand healthier lifestyle as well.
I'm, gonna have to put a link to thateither on the both on the website and
(33:56):
into this particular episode becausethat sounds information we need
to, exactly, really consume there.
Just to throw something additionalin there these this medical group
actually claims to reverse chronicconditions such as diabetes.
Really?
Now that's revolutionary.
So it's exactly, so their aim is toactually, have a healthier lifestyle
(34:21):
for their patients and and possibly,reverse conditions like that by
changing diets and getting them offtheir meds and things like that.
Awesome.
It's pretty, pretty impressive.
That is impressive.
If the help goes in thatroute, it would be great.
I hope so, because the good Lord hasblessed a lot of, intelligent people.
(34:43):
And it would be a shame if thoseintelligent people weren't allowed to
thrive, especially in this particulararea of, increasing one's standard
of living and wellbeing and health.
It would just be a shame.
And it's great to know thatthere's an organization like yours
(35:04):
that's on the front line of that.
Thank you.
Yeah.
Yeah.
So here's what we've heard today.
Navigating Medicare isn't just aboutfilling out forms or comparing charts.
It's about trust, clarity and makingsure no one gets left behind in a
system that can feel overwhelming.
And even to the experts,as a matter of fact.
(35:27):
My man here Leo Stella.
Correct?
Correct.
Go ahead.
Yeah, it's it's about gettingeducated and getting informed.
So yeah, you can make the best and wisestdecision when it comes to your healthcare.
Somebody's situation is not necessarilygonna be the best fit for you, so
you gotta talk to different people,get your information from wherever
you can, and just trust the experts.
People like myself, I know humannature is is the tendency of trusting,
(35:51):
let's say an uncle or a cousinor a brother or a sister, right?
But we might not be well informed, eventhough they have good intentions at heart.
Yes.
Yes, that's true.
That is so true.
Let's say, vinegardoesn't cure everything.
Exactly.
You can't put that on everything.
Exactly.
(36:11):
So it's you gotta, get in touchwith a broker like myself, like I
said, our services are at no cost.
We do get compensated.
We get paid by the insuranceplans through enrollments.
But other than that, any informationthat we provide and assistance that we
provide we don't charge the beneficiary.
We don't, we can't collect money,
You mentioned enrollments.
(36:32):
Perhaps in the next episode we can getinto enrollments and open enrollments
and that whole process there, 'cause I'msure that's pretty interesting as well.
So we'll keep that ontap for next time there.
Of
course.
Leo Stella and his team at Stella HealthInsurance Agency are doing something rare.
They're bringing humanity backinto the healthcare equation,
(36:55):
especially for seniors and in theunderserved communities who too
often or treated like afterthoughtsin our national policy debates.
Whether it's through one-on-one guidancecommunity meetups, or simply being
available when people need answers.
Leo's work reminds us that accessiblehealthcare doesn't happen by accident.
(37:20):
It happens because people care,people like Leo and that they act.
If you or someone you love is facingdecisions about Medicare or struggling to
understand what recent changes in DC mightmean to their coverage this is your cue.
(37:41):
Get informed, ask questions anddemand clarity because your health
and your dignity deserve nothing less.
So with that, I want to thankyou brother Leo, Stella.
For joining us and for the workyou continue to do every day when
(38:03):
you're not making things soundgreat as well in that space we'll
be watching these issues closely.
And as always, we'll keep diggingfor the truth here on it's that
part you are making that difference.
Thanks for being with us.
Take care of yourself andtake care of each other.
(38:26):
Thank you, Jesse.
Really appreciate youryour involvement in this.
You've got it.
today we're diving into somethingthat affects millions of Americans,
but doesn't always get the spotlight.
It deserves healthcare accessfor seniors and the quiet complex
battleground known as Medicare.
While Washington debates budgets andheadlines swirl about proposed cuts,
(00:23):
everyday people, especially olderadults, are left trying to make sense
of a labor of insurance options,prescription plans and shifting policies.
And for many, the stakes aren'tjust financial, they're personal.
Our guest today understandsthis better than most.
(00:47):
Leo Stella is not only a veteran inthe healthcare and insurance space.
He's the founder of StellaHealth Insurance Agency.
An organization built around a radicalidea that navigating Medicare should
be clear human and actually helpful.
(01:07):
Imagine that in these days, and inthis conversation we'll talk about
how Leo's agency is meeting peoplewhere they are with personalized
care, community outreach, and a deepunderstanding of the systems that
too often fail, the most vulnerable.
We'll also unpack a little bit thelatest changes coming out of dc,
(01:32):
what they mean for seniors and whyaccessible healthcare isn't just a
policy issue, it's a human right.
With all of this going on, I knewLeo would be the right person to
talk to, and he joins me right now.
Hello, Mr. Leo Stella.
(01:54):
Hi, brother Jesse.
How are you?
I'm blessed, nevertheless,in spite of all the rest,
happy Memorial Day, by
the way.
Awesome.
Yeah.
Same to you.
Same to you.
Thank you.
And everybody out there.
Just one correction I like to make.
I am please not the founderof Stella Health Insurance.
Oh, okay.
I promoted you.
Yeah.
Even though, which right.
(02:15):
So actually the founder of StellaHealth Insurance in the name of
the agency does have my last name.
So the founder is my cousin, Eric Stella.
Oh, okay.
And Yes, and he actually founded theagency about two years before I joined.
So we're talking about possiblyaround 2011, and I joined in 2013.
Okay cool.
That's a good good to know.
(02:37):
We'll have to have himon one of these days
for sure.
I'll pass the word along.
Cool.
Cool, cool.
But for now, we've gotthe one and only Leo.
Yes, sir. Yes, sir.
With that.
Go ahead.
Go ahead.
No, you go ahead.
Go ahead.
No, I was gonna say, to tell you a littlebackground about our agency and what
(02:58):
we're all about, please, at Stella HealthInsurance we're an independent insurance
agency focusing on providing clients witha personal approach to healthcare choices.
Our aim is to educate our clients onhealthcare choices with an expert in the
comfort of their home, their, our office.
And most of all, very importanthere, our services are at no cost.
What Now, of course, that, that mightbe something down the road on the line
(03:22):
of questioning or whatever, but thatgives me pause right there and should or
probably get a hold of a lot of people.
Pause free.
No, excuse me.
No cost.
No cost.
Correct.
And it's funny because there are certainterminology that we're allowed to use.
There's, there's an organization a federalorganization called CMS, which I refer
(03:43):
to as the FBI for Medicare, and theyregulate Medicare and and basically are
there to protect all the beneficiaries.
Okay.
They're like the Medicare policeand they watch everything we do.
So that medic, Medicare beneficiaries
are protected.
Are they independent of thefederal government, or are they
a subsidiary or arm of somethingelse within the federal government?
(04:06):
No, it's within the federal government.
They're connected to to Social
Security and Medicare itself.
So they didn't get affected by Doge,
by what?
I'm sorry?
Doge.
DOGE?
No.
Yeah.
I don't think so.
No.
Yeah.
'Cause I know a lot of.
Or many agencies, watchdog agencies orwhatever in particular, one thing that
(04:29):
comes to mind, the civil rights divisionof the Department of Defense, for instance
that's been, gutted out and the igs werefired and other areas there which were in
place as watchdog type of, organizationswithin the federal government.
It's good to know that they're still therebecause I would guess they're a legacy
(04:53):
organization and that they've been there,they're career, healthcare, professionals.
Would that be a fair statement?
I believe so, yes.
Okay.
Yeah.
That's good that they're in place,for, especially for the consumer.
Of course.
Of course.
Like I said, they're the watch dogs.
They.
(05:13):
They watch everything we do as agentsso that we don't take advantage.
There's a lot of unscrupuloussalespeople out there.
And their practicesaren't always the best.
To say the least,
to protect the Medicarepopulation, our seniors.
Correct.
Hey can you along those lines, can youshare a story that highlights how your
agency has made a tangible differencein a client's healthcare journey?
(05:40):
There's so many stories out there, andwe focus on, basically educating Medicare
beneficiaries are mostly seniors.
Don't necessarily need to be a seniorto be a Medicare recipient, but yeah.
So we're out there to basically educatethem so they can make the best choice
when it comes to their healthcare options.
A lot of people tend to go by whattheir friends say or what they're being
(06:03):
recommended by hr if they're, planningto retire at a particular moment and
they just trust individuals insteadof getting general information just
really in depth educated info so thatyou can actually make the best choice,
the wisest choice for your healthcareand your pocket as well, because you
might actually end up paying moneythat you don't need to be paying.
(06:24):
So now they'll find thisout through consultation.
What's the process?
How would this process startfor the the average individual?
I don't know.
You said that they don't haveto be seniors or whatever.
So for the average individual howwould they start this process?
How would they know about your agency?
(06:46):
The agency, it's justlike any other agency.
We're being marketed outthere on social media.
You might see some ads on Facebook,Instagram, and I have, and mailer, and
basically, the way Medicare works isonce you're reaching the age of 65 for
most people the window of enrollment,the initial period of enrollment for
(07:08):
Medicare, it's a seven month window.
So it starts with three monthsprior to your 65th, 13 month.
And it goes all the way past threemonths past your 65th, 13 months.
So you got seven months to enroll intoMedicare, and that's original Medicare,
which is composed of four parts,but we'll get into that in a minute.
Okay.
So during those seven months, you canactually do your research, your homework,
(07:30):
and see what the best option is for you.
You start, you will startgetting bombarded with phone
calls and mailers usually.
About the time you turn 64.
'cause they want you tostart preparing for it.
So that's when you start digging aroundand see what your best options are.
And my recommendation is to speak toan expert instead of just going on your
own or a recommendation from a family,member or or a coworker per se, right?
(07:53):
You, they whatever fits them and itexcluding them, might not necessarily
be the best option for you.
Okay.
So if you'd we can go into a brief,like Medicare 1 0 1 and go step by
step to, so that the audience can know.
I think works.
I think that would be good becauseI mean there is, just a whole lot of
(08:13):
things going on right now and, maybewe'll touch on some of them down
the, in a few minutes here or so.
But and you mentionedsomething that was, new to me.
You said that that this was theold or original Medicare opposed
to I guess the new Medicare?
So I know a lot of people would benefitfrom, just knowing more about it because
(08:40):
a lot of the information that's comingout of DC I guess for better or for worse
or whatever we don't really know what tobelieve, because there's a lot of people,
I'll just be frank, a lot of people lying,and then you've got, these other agencies
was that Medicare Plus or Advantage andall these other organizations that are
(09:03):
popping up claiming to bridge the gapand wanting to help you out or whatever.
But it just seems likeit's another racket there.
So if you could take usthrough that would be great.
Sure.
Just to clear one thing up rightoff the bat, Medicare, original
Medicare doesn't refer to an oldversion of Medicare versus a new one.
(09:26):
Original Medicare is actually whenyou when you only get Medicare
provided by the government.
So basically.
Who's eligible for Medicare, peoplethat are turning 65 or older.
You can also be eligible forMedicare if you're under 65 if you
have a social security disability.
So if you're receiving SSDI, sosocial security disability benefits
(09:48):
for a minimum of 24 months and you'reunder 65, you can also be eligible
to receive Medicare benefits.
Okay?
Also, if you have an illness ofend stage renal disease or a LS
Lou Gehrig's disease, you're all atany age, you can also be eligible
for Medicare, and you must be a UScitizen or a per permanent resident
for at least five consecutive years.
(10:10):
This makes you eligible toreceive original Medicare.
Okay.
Now, original Medicare is composed offour parts, and those parts are parts A,
B, C, and D. And let me go through whateach one of those parts mean please.
So basically part A.It's hospital insurance.
(10:30):
It provides coverage for inpatienthospital care, skilled nursing facilities,
hospice care, and some limited homehealthcare among other services.
Part A is earned by having workeda minimum of 40 quarters or 10
years legally in the United States.
And you must have paidtaxes during those 10 years.
Okay.
That's given to you automatically if youhave those requirement requirements met.
(10:54):
Part B of Medicare is optional andit comes with a monthly premium.
That monthly premium tends to changefrom year to year, and there are
periods of time where the, the me, thepremium, the Part B premium stays pretty
steady, but for the past few years,it has changed and it has fluctuated.
Last year it was $174 and 70 cents.
(11:16):
This year for 2025, it went up to 180 5.
The coverage for Part B is doctorvisits and preventive services,
outpatient surgery, emergencycare and durable medical equipment
among some, a few other things.
Now, like I said MedicarePart B is optional.
(11:36):
The thing is that in order to qualifyfor Part C, which are Medicare
Advantage Plans, and these arethe plans that I mostly work with.
You need both parts A andB. So what does that mean?
So you pay you, you have PartA, you know you earned it.
By having worked those 10 years,you choose to activate Part B with
(11:57):
that monthly premium that makesyou eligible for Part C, which
are the Medicare Advantage plans.
These plans come with no monthly premiums,no deductibles, and the majority of
services are covered at a $0 copay,at least here in Southern California.
Copays and deductibles tend tochange from from state to state.
But for the area that I work,Southern California, that's
(12:20):
usually the way it works.
Okay.
Now, so I touched upon, part A, B,and C. Part D are prescription drugs.
So it's coverage for presfor prescription drugs.
Now these part C plans are all inclusive.
So basically you have a B, which areoriginal Medicare, and then by law
(12:42):
you must enroll into a Part D plan.
Those plans, if you do a standaloneplan, usually come with a monthly
premium, and those premiums actuallyhave gone up this past year.
And it varies from carrier to carrier,but you can expect to pay maybe around
upwards of 15 and more for a monthlypremium if you get a prescription,
a standalone prescription drug plan.
(13:03):
Now going back to the Part C plans.
These Part C plans are all inclusive,so you get part everything.
That part A covers everything thatpart B covers, and then everything
that Part D covers all in one.
And like I said before, these plansdon't have any monthly premiums, no
deductibles, and the majority of medicalservices are covered at a $0 copay.
And since that Part D coverageis embedded, you don't have
(13:24):
to pay that premium for theprescription drug coverage.
Now, you said that you you arecompelled or we are compelled to
receive part D coverage by law.
How, can you expound on that alittle bit more as far as why
(13:45):
is it compulsory to do that?
What?
To be honest, I don't know theexact origin of why it's mandatory.
But it is the law.
If you choose not to activatepart D or part B, right?
And later on down the line, when yourhealth guard deteriorating or you find
the need for those types of coveragesif you have waited more than a year
(14:09):
from the moment you were originallyeligible, you could incur penalties.
Wow.
And and then Exactly.
And then you wanna try to avoidthose penalties by enrolling
into those coverages on time.
Now there, there are peoplethat can not necessarily get
away, but avoid those penalties.
And that's usually because they havehad, or continue to have passed the
(14:30):
age of 65 coverage through work.
So if they have coverage, medical coveragethrough work, that means that they
have a, an eligible or comparable plan.
That meets the requirements from thegovernment for you to have that coverage.
So if you've had, if you're 67, 68and you're still working and you have
coverage through work, that means thatyou're have, you have medical coverage
(14:52):
and coverage for your medications, andyou're not subjected to those penalties.
Now the moment that coverage ends, oryou decide to cancel it, then you have
to worry about activating those policies,those coverages, so that you don't incur
those penalties a year from that point on.
Okay.
I understand.
I mentioned earlier that, that there wasa lot of things going on in dc what are
(15:15):
your thoughts about the recent Medicarepolicy, at least the proposed changes?
I know that the Senate still hasto take a crack at and everything.
The house is already approved the cuts.
And so I'm just wondering, how do they howmight they affect the average beneficiary?
(15:36):
You know what, we don't havemuch information on that.
It's just like a wholebunch of speculation.
We keep hearing that our presidentis trying to get rid of Medicare
altogether and this and that.
And to be honest, I haven'theard anything myself where
it's actually gonna take place.
And obviously, people will getscared and they feel that it's
gonna affect them negatively.
But as far as like actual changesthat happened before the end of 2024
(16:00):
that were gonna be implemented for2025, I can tell you, prescription
drug coverage was gonna change.
So this is part D of Medicare.
There was a reduction in the annualout-of-pocket cap for Part D. Right.
And and something we call the donut hole,which is the gap for Medicare changed.
So it got, it pretty much got eliminated.
So before, up to 2024 if you hit acertain amount in expenses through
(16:24):
your your prescription drug use,you would hit and enter a face
call the donut hole or the gap.
And that amount was about $5,000.
Let me look it up really quick.
But once you hit that donut hole,you basically started paying
(16:45):
here about 25% of yeah.
So the initial coveragelimit was 5,000 $5,030.
So once you hit that limit,you were gonna start paying 25%
of the cost of generic drugs.
And brand name drugs.
If you had expensive medications,you were definitely gonna go
up there and go there, right?
(17:07):
So then your the cost of yourmedications was gonna go up,
your expenses were gonna go up.
If you reached the next phase, whichwas called the catastrophic stage,
and that was at $8,000 out of pocket,you your expenses would actually go
down and you would pay the lessercost of either 5% or the actual cost
(17:27):
of the medication, whatever, like thecopay that the plan would offer you.
So that's changed.
So now they changed it to where the,I guess there was only you would go
directly into the catastrophic stage.
So once you hit a $2,000 out of pocketlimit you in 2025, you go directly into
the cata, which means that at that pointyou don't pay anything for the remainder
(17:48):
of the years for your medications.
It's gotten better in favor ofthe beneficiaries, especially
those that have expensive drugs
Now, do you expect that to change
Or is that a part of the rumorsand propaganda that's going around?
That part right there would change andall of a sudden costs will go up and some
(18:11):
people will be even, kicked off the roll.
I hope not because as it is some of theother changes that were happening were
certain medications were being droppedby plasma and not being covered anymore.
So that wasn't a, such a good thing.
But in regards to the actual,out of pocket expenses.
I think it benefits all those chronicallyill, patients that have expensive drugs
(18:34):
because to tell you the truth in myexperience, when you run into healthy
Medicare beneficiaries and they'reonly using like generic drugs and you
only have like maybe a handful thatat most those medications tend to be
covered at a $0 copay with most plans.
So them hitting that donut hole orthe catastrophic stage is very rare.
(18:54):
So it's mainly help for those peoplethat have, chronic conditions,
that have expensive drugs.
And I hope it doesn't change, we don'tget news like that until we're getting
close to the annual enrollment period,which takes place between October 15th
and December 7th prior to that, we startgetting some trainings and we start
getting informed on the changes thatare happening for the upcoming year.
(19:16):
If you could share, you don't haveto share the exact, conversation or
whatever, but are you receiving a lotof calls and or emails or contacts from
beneficiaries or just people curiousabout what's going on with Medicare
as it relates to the changes thatare coming out of out of Washington?
(19:38):
No, not really, to be honest.
The average beneficiary just, isworried about not spending too much
money and having good coverage.
And these plans are great.
It's one of the good things aboutour agency that we're actually
like a brokerage company, right?
Where we contract with multipleplans, especially the big hitters like
UnitedHealthcare, blue Shield, blueCross, but we have options to offer.
(20:02):
So all these Medicare optionsand plans are not cookie cutter.
They're not necessarilytailored either, right?
So what we do is we do an analysis oftheir medical needs and we also do a cost
analysis of our, their medications tosee what plans you're gonna give them.
The best coverage.
At the lowest cost, basically.
And so they do the the potentialbeneficiary or the beneficiary,
(20:26):
they receive all of this helpfrom your agency at no cost.
Correct.
That's, that sounds like a whole lot
compensated.
Yeah.
No, and that's the thing.
Medicare can be overwhelming.
Yeah.
Like I said, once they turn, beforethey're gonna start getting all
these this correspondence, phonecalls, and it can be very confusing.
(20:47):
Or even those TV ads with with Mr.Football player and everything.
Sometimes people will get into trouble.
Exactly.
People will get into trouble becausethese are trusted figures, pop, yep.
People in the industry that, thatgain their trust and they'll make
that phone call and the person onthe other end doesn't necessarily
have their best interest in mind.
So they'll get them enrolled into a planwithout doing the proper background check,
(21:11):
make, making sure that all their doctorsare in network, that their medications
are covered at the lowest cost.
They basically enroll them intoa plan just to make that dollar.
That's not what we're all about.
We dig deep, make sure that all theirdoctors are covered, that's the way they
want to go, and we'll recommend two tothree plans at most, which will give them
the best coverage at the lowest cost,basically, and save them some money.
(21:34):
And like I said earlier,there are options.
Once you turn 65, you can go with originalMedicare, which is just A and B, or
just keep, a lot of people keep just a,because they've earned it and they don't
activate part B. But then later on downthe line, they might run into issues
because they need to activate Part Band then those penalties come into play.
The other option would be PartC, the Medicare Advantage plans.
(21:55):
The third option wouldbe Medicare supplements.
Now Medicare supplements theydifferentiate themselves from
Medicare Advantage plans inthat they're like a like PPOs.
Okay.
Because Medicare Advantageplans are HMO plans where you're
bound to a network of doctors.
Oh, okay.
Network.
You can't freely go to a special.
(22:16):
You have to get a referraland this and that.
And I know that, for a verylong time, HMOs have had a
bad rep, a bad connotation.
But in my experience, honestly, I can tellyou that the speediness of getting those
medical services depends on what medicalgroup you affiliate yourself with, right?
So we tend to work with medical groupsthat are, that expedite, referrals that
(22:38):
have high need and things of that sort.
So they tend to not take too longto get a referral authorized and
approved so that they can make theirappointment with the specialist.
Now, getting back to the Medicaresupplements give you the freedom to go
anywhere you want, but the catch is thatthese plans, unlike Medicare Advantage
plans, don't offer all the extras andthey come with a monthly premium, right?
(23:01):
Remember, so Medicare Advantage plans,no monthly premium, no deductible,
and the majority of services arecovered at zero Medicare supplements.
Come with a monthly premium, whichis based on your age and your zip
code, and they don't carry all theextras that Medicare Advantage plans
have, such as vision coverage, dentalcoverage hearing, and a whole bunch
of other perks like transportation,gym membership, and allowances for
(23:24):
over the counter drugs, groceries,and even utility bills, zip codes.
The other thing is go ahead Justin.
I'm sorry.
No.
That that that phrase just stuckin my head there that depending
on your zip code that woulddetermine your coverage as well.
Yeah.
It determines the monthly premium Yeah.
That you would have to pay.
(23:45):
Some areas of the county or the stateare more affluent than others, so
depending on your age and your zip code.
They determine the monthly premiumthat you would pay for a Medicare
supplement, and it's basicallyyou're paying for a luxury, right?
To have that freedom to, without havingto wait for a referral to get authorized.
That's the and I'm very familiar withthe PPO and HMO systems there working
(24:10):
in corporate America for many yearsI was always a PPO type of guy there.
Although as a service member, Idon't know what you would call that,
because, everything was, no costand free and usually got, the best,
that there was, on, on a particularbase that whatever particular
base you found yourself on there.
(24:31):
I've, I have tried the HMO route there.
But I must admit, I wasn't a big fanof reaching a particular threshold or
criteria or whatever to get a referral.
So I've been as they say, payingout the nose for years for PPO
so that I can go to where I want.
(24:52):
Plus, I, I've had the same doctorfor, many years, but that's just me.
I know that, that
was a question, that wasa question from me to you.
Did you try both systems, the PPOand HMO system with the same doctor?
Not with the same doctor becauseI was in different different
places at different times.
That's where the difference comes.
(25:12):
Like I said, if you have, itwould be a fair comparison.
If you could say that when you had theHMO with a particular doctor versus
the PPO with that same doctor, you weretreated differently and the quality
of your healthcare was different.
But with the doctors that Iwork with, they take both.
So the quality of medical care.
It's the same, it's only thespeediness of how quickly you can
(25:35):
see a specialist, for example.
And like I said, in most cases you canget an authorization, sometimes you can
even walk out of your appointment withan authorization approved in your hand.
That means that you can callright away and make an appointment
to see your specialist.
And depending on the specialist andavailability, that's how quickly
you can see that specialist.
Yeah.
And I know a lot of people, in fact ourmutual friend that would normally be
(25:58):
with me and one this we've got a coupleof different podcasts going on, but one
of the podcasts the Healthy, wealthyand Wise podcast would normally have a
person that's near and dear to both of us.
Dr. Choctaw.
Yes.
Now he.
He would swear by Kaiser, and I don't meanto name drop, on this episode or anything
(26:19):
like that, he had no problems with them.
And I think it's been a long time,but I think I had a bad experience
with him or whatever and I neverwent back or something like that.
And then I've heard other horrorstories, depending on which Kaiser
you went to and all of that.
But but yeah, he held them in high regardand I know a lot of other people hold that
(26:42):
particular organization in high regard.
Yeah.
I was gonna, chime in on that, thateverybody has a different experience.
It's like with every product, everyservice, some people are gonna
have a good experience, others aregonna have a terrible experience.
So it's like you can't really saythat one's better than the other.
It
comes to Kaiser us as brokers.
(27:04):
We're having, we haven't been allowedto, let's say, contract with them.
'cause otherwise we wouldn't, wewould need to have exclusivity.
So we wouldn't be able to sell other plansthat have different options to offer.
Okay.
So I know a couple of years ago therewas talk that Kaiser was finally
gonna open their doors for us brokersto be able to offer their services
and their Medicare plan as well.
(27:25):
Okay.
Along with the ones that we already do,
what happened,
but it still hasn't happened.
Oh.
So when I run into a Medicare beneficiarywho's been a long time Kaiser member, it's
usually a really almost impossible sale.
Yeah.
Yeah.
There, there's a lot of peoplereally connected to that
organization, very loyal to them.
And evidently for goodcause or good reason.
(27:50):
Now, Hey
Exactly.
And like I said, not everybody hasa pleasant experience with them.
I'd say about five, six years ago I wentto go see a client of mine, this older
lady and her son-in-law was sitting at thetable with us and he was a Kaiser patient.
So we began to talk and he told methis story that during the year he
(28:11):
had a surgery which he spent about,I think like somewhere between
200 and $400 for the surgery.
And then and medication costs.
He was spending about the same per year.
And I told him, let me do a quickcheck on your medications right now.
Let me run the cost and see whatit would cost you with a plan
like your mother-in-law has.
(28:33):
And so right off the bat I told himthe surgery itself would have cost
you zero if you would be in a planlike the one that your mother-in-law
has, and your medication costwould be reduced to $20 per year.
His eyes got wided open.
Mine just did too.
Considered changing, exactly.
At the time the benefits forKaiser's Medicare plan were
(28:54):
like, the copays were higher.
I don't, I'm not updatedon the cost right now.
They might be a lot more comparable now,but back then they had higher costs.
It was like almost like a no brainer.
I got 'em to switch.
I convinced them to switch.
I got that enrollment on the spot.
The only catch is that if they wantchange plans, since Kaiser doesn't take
(29:14):
any other, carriers like Blue Shield, anyother outside, companies, he would have to
have changed doctors and he agreed to it.
I imagine that as we progress throughlife and get to certain stages, we.
We do make certain changes, make certainadjustments that we've held on to perhaps
(29:35):
for years or whatever, but now it makesbetter sense to go a different direction.
It's always a good idea to testthe water somewhere else and see
if it is gonna benefit you or not.
There's always the option of going back.
So every time somebody hesitatesto let's say, for lack of a
better word, take my advice.
(29:56):
I always tell 'em, you can alwaysgo back, but give it a try.
Give it a try.
And if you feel that you're betteroff, then I did you a favor.
That's fair.
That's definitely fair.
Totally.
Now does Estella Healthcare InsuranceAgency you're involved with community
outreach to a degree, right?
Yes.
(30:16):
We periodically do Medicare one oh ones.
We'll set up seminars, we'll do shopsto talk about LIS, which is low income
subsidy, which is another name for thatis Extra Help, Medicare Extra Help.
So it helps reduce thecost of their medications.
And this is, you qualify ifyou're low income, obviously.
There's another program called QMB,which helps pay the monthly premiums
(30:40):
for premiums and deductibles forparts A and B. And we do outreach
like that for the community.
We also work with Medicarebeneficiaries who have Medi-Cal.
So these are called Meeds, right?
They have both Medicare and Medi-Cal.
These beneficiaries actually have aslightly different option of Medicare
plans where they actually get.
(31:01):
Additional coverage and those extraperks, those extra services that
these Medicare Advantage plans offer.
If they were to be just strictlyMedicare Medi-Cal recipients, they
would be missing out on a whole bunch ofother stuff that's out there for them.
I see.
Looking ahead, what are some of thekey challenges and opportunities
that you can foresee in thehealthcare insurance landscape?
(31:29):
What do you mean exactly?
Again, referring to the changesthat are coming down the pike
there, whether or not there were anychanges or not we've got, artificial
intelligence doing scannings andqualifications and things of that nature.
Just, other technology comingonline designed to either increase
(31:51):
mortality rates and or decreased cost.
There's just a number of thingsout there that would that will
affect, the healthcare insuranceend of the business there.
And I was just wondering what whatyour thoughts on any of that was
or what do you see down the road?
(32:11):
I'm hoping that, the cost forthe beneficiaries remains,
controlled and and low.
Like these these MedicareAdvantage plans are designed to do.
'Cause I would hate forseniors to start paying more.
The other thing that that I see happeningis a focus on preventive care, right?
As opposed to keeping beneficiarieswith their expensive medications.
(32:33):
Medications that sometimes may haveside effects and things like that.
There are medical groups that arefocusing on preventive care at keeping
these beneficiaries healthy so theycan have a better quality of life.
There's there's a new medical group that'sfocused on the approach of the Blue Zones.
I don't know if you'refamiliar with the Blue Zones.
No, I'm not.
(32:54):
The Blue Zones, there's a a documentaryon Netflix where there's five zones
around the world that have thehigher volume of Centurion people
that live past a hundred years old.
So they did some research wherethey're finding out their habits,
their lifestyle, and everything to seewhat's causing them to live longer.
(33:15):
And it's based on, a healthier lifestylein regards to diet, less stress.
There's a few of these that are likeold style villages where they're,
modern technology doesn't affect themas much as, the rest of the world.
And staying away from that alsocontributes to their long life.
And there's a few other elements,but if you get to watch that
(33:36):
documentary, it's pretty great.
Okay.
So this medical group it is connectedto that original documentary and
their approach is that, preventivecare having an input in regards to
beneficiaries having a longer lifespanand healthier lifestyle as well.
I'm, gonna have to put a link to thateither on the both on the website and
(33:56):
into this particular episode becausethat sounds information we need
to, exactly, really consume there.
Just to throw something additionalin there these this medical group
actually claims to reverse chronicconditions such as diabetes.
Really?
Now that's revolutionary.
So it's exactly, so their aim is toactually, have a healthier lifestyle
(34:21):
for their patients and and possibly,reverse conditions like that by
changing diets and getting them offtheir meds and things like that.
Awesome.
It's pretty, pretty impressive.
That is impressive.
If the help goes in thatroute, it would be great.
I hope so, because the good Lord hasblessed a lot of, intelligent people.
(34:43):
And it would be a shame if thoseintelligent people weren't allowed to
thrive, especially in this particulararea of, increasing one's standard
of living and wellbeing and health.
It would just be a shame.
And it's great to know thatthere's an organization like yours
(35:04):
that's on the front line of that.
Thank you.
Yeah.
Yeah.
So here's what we've heard today.
Navigating Medicare isn't just aboutfilling out forms or comparing charts.
It's about trust, clarity and makingsure no one gets left behind in a
system that can feel overwhelming.
And even to the experts,as a matter of fact.
(35:27):
My man here Leo Stella.
Correct?
Correct.
Go ahead.
Yeah, it's it's about gettingeducated and getting informed.
So yeah, you can make the best and wisestdecision when it comes to your healthcare.
Somebody's situation is not necessarilygonna be the best fit for you, so
you gotta talk to different people,get your information from wherever
you can, and just trust the experts.
People like myself, I know humannature is is the tendency of trusting,
(35:51):
let's say an uncle or a cousinor a brother or a sister, right?
But we might not be well informed, eventhough they have good intentions at heart.
Yes.
Yes, that's true.
That is so true.
Let's say, vinegardoesn't cure everything.
Exactly.
You can't put that on everything.
Exactly.
(36:11):
So it's you gotta, get in touchwith a broker like myself, like I
said, our services are at no cost.
We do get compensated.
We get paid by the insuranceplans through enrollments.
But other than that, any informationthat we provide and assistance that we
provide we don't charge the beneficiary.
We don't, we can't collect money,
You mentioned enrollments.
(36:32):
Perhaps in the next episode we can getinto enrollments and open enrollments
and that whole process there, 'cause I'msure that's pretty interesting as well.
So we'll keep that ontap for next time there.
Of
course.
Leo Stella and his team at Stella HealthInsurance Agency are doing something rare.
They're bringing humanity backinto the healthcare equation,
(36:55):
especially for seniors and in theunderserved communities who too
often or treated like afterthoughtsin our national policy debates.
Whether it's through one-on-one guidancecommunity meetups, or simply being
available when people need answers.
Leo's work reminds us that accessiblehealthcare doesn't happen by accident.
(37:20):
It happens because people care,people like Leo and that they act.
If you or someone you love is facingdecisions about Medicare or struggling to
understand what recent changes in DC mightmean to their coverage this is your cue.
(37:41):
Get informed, ask questions anddemand clarity because your health
and your dignity deserve nothing less.
So with that, I want to thankyou brother Leo, Stella.
For joining us and for the workyou continue to do every day when
(38:03):
you're not making things soundgreat as well in that space we'll
be watching these issues closely.
And as always, we'll keep diggingfor the truth here on it's that
part you are making that difference.
Thanks for being with us.
Take care of yourself andtake care of each other.
(38:26):
Thank you, Jesse.
Really appreciate youryour involvement in this.
You've got it.
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