May 30, 2024 • 33 mins
In this episode, our special guest Kevin Anderson, a licensed Medicare Advisor, will walk host Dennis Day through the process of choosing the right Medicare health care plan, just like he would any other client age 64 and 9 months.
Learn the timing for enrolling three months before or after your 65th birthday to avoid coverage gaps, and understand the roles of Medicare Part A and Part B. We'll also discuss the critical steps to setting up your SSA.gov account and the value of supplemental coverage. Whether you're a first-time enrollee or looking to optimize your existing plan, this episode is packed with insights to help you navigate Medicare registration efficiently and effectively.
Explore the critical differences between HMO and PPO plans, and discover why UnitedHealthcare's extensive network might be your best bet, especially if you're in Washington state. We highlight the often-overlooked benefits of acupuncture, chiropractic, dental, and vision care, and provide strategies for coordinating benefits with your employer’s plan to minimize out-of-pocket expenses. Kevin shares his expert advice on avoiding common Medicare pitfalls and the benefits of consulting a seasoned Medicare agent. Tune in for a thorough understanding of Medicare and actionable tips to tailor the best plan for your needs.
Kevin Anderson
Licensed Medicare Advisor
360-355-6555
medicarekev@gmail.com
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dennis Day (00:03):
Good day everyone.
This is Dennis Day with Gettingyour Edge how to Right Size
your Home and Life podcast, andI'm here with Kevin Anderson,
who is a Medicare specialist,and we're going to discuss how
to sign up for Medicare and getyour plan chosen.
I am one month away fromturning 65.
(00:23):
Uh-oh, am I in trouble?
Kevin Anderson (00:25):
Kevin, you're not in trouble at all.
No, you're perfect timing,perfect.
Dennis Day (00:30):
Because everybody keeps saying oh Dennis, you were
supposed to do that months ago.
Kevin Anderson (00:36):
Kevin said it was okay.
Apologize for the coughing.
I'm getting over bronchitis.
I'm getting over bronchitis,but you have an open window
through Medicare that startedthree months prior to your
birthday month and extendsanother three months after your
birthday month.
So as long as you get it donewithin that time frame
(00:57):
preferably, like you are yourbirthday is in June.
So what we zero in on your plantoday and figure out what might
be the best for yourconsideration it'll actually
start June 1st, so you won'thave any gaps.
You won't have just originalMedicare to rely on, which will
start on June 1st for you.
So did you get your Medicarecard in hand, Dennis?
Dennis Day (01:19):
No, I haven't signed up for the Medicare card.
I got my social securityaccount created.
Ssagov Created that fullaccount password, lots of checks
to avoid fraud and so forth,and then the next step was sign
up for Medicare.
Before we go farther, Kevin,can you tell our audience who
(01:41):
you are and what you do?
Kevin Anderson (01:42):
Oh sure, I'm Kevin Anderson.
I'm out of Long Beach,washington.
I work up and down the I-5corridor in Washington for
Medicare.
I'm a premier gold agent withone of the carriers,
unitedhealthcare, and I've beendoing insurance since 1997.
The last 13 and 14 years, 100%Medicare.
(02:06):
So my name is on an insuranceoffice in Longview, washington,
on the door.
The gals in there do everythingthat they need to do for other
insurances.
I only do Medicare.
It's quite the beast thatCongress has built and there's a
lot of ins and outs and a lotof changes all the time, every
year in fact.
(02:27):
So what I would suggest forthose listening is 90 days or 89
days prior to your first day ofyour birthday month.
Do what Dennis did go to ssagovor myssagov and make sure that
you've set up an account.
You can decide whether you'regoing to take social security or
not at 65, or you might extendit out, like I did, to full
(02:51):
social security.
Age In my case was 66 and ahalf.
More importantly, this is aboutMedicare.
So most of the time I don't knowwhat percentage, 90% of the
time Medicare is pretty good atkeeping track of you and they
know when your Part A and yourPart B will start and they'll
correspond with you.
They won't talk to you 91 daysprior to the first day of your
(03:15):
birthday month.
You have to wait until you'rewithin that window and I
recommend those that arelistening do that right away, as
soon as you're eligible,because it could take them
several weeks Now in Dennis'scase, when we're done here, I'll
actually look him up and see ifMedicare has kept good tabs on
him.
What I mean by good tabs iswhen we move.
(03:37):
If you've moved in the lastfive years four or five years
Medicare may not have yourcurrent address to send you
correspondence, so that's whereyou could fall into the crap.
Dennis Day (03:48):
I've been at my place for I don't know since 19
uh 1999, man 1998 oh, you'velived in the same address.
Kevin Anderson (03:59):
Yeah, wow, that's, that's fantastic.
You're in real estate.
How often does the averageperson change residence?
Dennis Day (04:08):
I used to be every seven years.
Now it's hard to say.
For some people it's sooner andfor a lot of people it's a
little longer now becausethey've been living in those.
Most of the baby boomers havebeen living in this one house
for a great deal of time.
Kevin Anderson (04:25):
And with interest rates several years ago
down in the 3% range.
And what are they today?
Seven?
Dennis Day (04:31):
Yeah, you're going to look at a seven or so plus or
minus.
Kevin Anderson (04:37):
Back to Medicare .
So we'll check when we're donehere, once we zero in on which
plan is going to be best for you, dennis, we'll check.
There might be some other stepsthat we'll have to do.
So that's why I encourageeveryone, 90 days prior you can
even call 1-800-MEDICARE ifyou'd rather do it on the phone,
but be prepared to wait a while.
And with myssagov you can alsoset up a phone interview and
(05:00):
they'll do it about a week outand that's kind of convenient
also.
So Medicare A and B those of usthat have worked at least 10
years, we receive our Medicare Aand B at age 65 or sooner.
With a two-year history ofsocial security SSI, income,
disability kinds of things fortwo years.
(05:20):
You can actually get it earlierand I have clients in there.
I have one client in his 30s.
He's in his 30s.
I have others down in the below20 years old that are on
Medicare.
So, but typically it's when youturn 65.
Part A is hospitalization.
In very general I'm only goingto spend two minutes on this
(05:41):
Hospitalization.
The first day in a hospital onoriginal Medicare you'll pay a
$1,600 deductible.
Then there's a per day charge.
You could pay up to $80,000 or$90,000 on your Part A if you
don't have any other coverage tohelp with the gaps.
Part B pays your doctor, yourtests, your MRI, your CAT scans,
and I had a slug of those thisyear.
That's why Medicare Part B pays80%.
(06:08):
You pay 20%.
So it's a good idea to haveanother supplemental plan of
some sort to pick up that.
That can be expensive.
So I'm going to ask you somequestions, dennis.
Congress has delineated thebenefits of what's called
Medigap policies or supplements.
Those are the same no matterwhat company you go to.
(06:29):
But that's one beast andthere's reasons why 5% or so of
people choose that.
The other one is Advantageplans.
Those are administered by athird party.
Those are never the samebenefits between companies and
all of the ones that do havebuilt-in drug plans.
The formularies are alldifferent.
So it's really important to getan agent, find somebody you
(06:52):
trust that can plug in yourprescriptions.
Make sure that the formulary inthe Advantage plan is the best
for you, my wife and I.
My wife does Medicare as well.
Several years back we had awoman whose drugs were $20,000 a
year.
Wow, now that's impossiblebecause Congress is trying to
(07:14):
get rid of for the last severalyears, that awful thing called a
donut hole.
So now, once you've paid inlike $7,000 or whatever it
actually is, at the moment itpays 100%, so you can't get to
20,000 anymore, but anyway.
So let me ask some generalquestions.
You're up in King County, right?
Dennis Day (07:34):
Yes.
Kevin Anderson (07:35):
So do you stay in King County physically at
least six months a year?
12 months a year?
Yes, okay, if you are asnowbird and are gone more than
six months a year, you couldstill buy an advantage plan and
probably won't have any issues.
The requirement is that youspend six months a year in your
county of residence A companylike Humana or Unite Healthcare.
(08:00):
If you have a seven or $800,000bill, they're going to look
into you.
They find out you're cruisingthe world 10 months a year.
They're going to refund yourpremiums and not pay your bill.
Wow, so you want to just followthe rules and you said yes, so
you qualify for an advantageplan.
I'm assuming you're on amedical plan now.
Perhaps your work?
Dennis Day (08:20):
Yes, my wife has a pretty good benefits.
She works for a local schooldistrict and she covers me.
I don't know how much she paysadditional for my coverage, but
yeah, I have a good plan.
Kevin Anderson (08:36):
So okay, On the plan you're on now, what kind of
benefits do you really enjoy?
What is important to you on theplan that you're on now?
Dennis Day (08:45):
The plan I have is kind of an HMO, so I like the
fact that the drugs are fairlyinexpensive.
I do have low deductibles.
January 1st I start over andI'll be required to keep paying
until I pay a certain amount andI don't remember how much it is
(09:06):
.
Then everything is covered,with the exception of co-pays
and so forth that I like.
My co-pay is $20.
In past years it's been $15.
I like the convenience of awhole network, meaning that I go
to a specialist that's withinthis HMO group right.
(09:30):
Whereas my mother who's onHumana, she's part of a group
but she can go to all theseother different places, but I
found that they don'tcommunicate.
So when she goes to aspecialist, that's great, she
gets help, blah, blah, blah, butnothing goes to her regular
doctor, unless I make thathappen for her, et cetera Got it
(09:53):
.
So within this I'm within onesystem and all my records kind
of housed in one spot thateverybody within that system has
access.
I really like that.
Kevin Anderson (10:04):
I understand and I'm hearing you.
Let me set everyone's mind atease.
Any advantage plan that I'maware of, at least in the state
of Washington, oregon and Idaho,the states that I'm licensed in
have no deductibles.
There is no deductible.
There are copays, but what youwere just sharing is every
(10:24):
January you have to start bypaying off your deductible
before you can get to yourco-pays.
That doesn't exist withAdvantage plans.
Very few supplements.
It has to be a high deductible.
Well, fs aren't availableanymore, but G plans.
There are high deductible Gsthat will have a deductible
(10:45):
1,800 or whatever it is per year.
But overall most Medicare plansdo not carry deductible.
What they do have is what'scalled maximum out-of-pocket,
mooc.
Your maximum out-of-pocketannually changes, not with
supplements.
There is no maximum.
(11:05):
You could charge $2 million andit's going to pay it all.
With an advanced plan you havea maximum out-of-pocket.
So if your co-pays you don'thave a deductible.
But if your co-pays ever reacha certain number and it
typically ranges between $4,000and $6,500, depending on the
plan but say you reach $6,000,the rest of the year 100% of
(11:27):
your medical is covered.
So it's not deductible.
That's a sum, your total sum ofyour co -pays.
So that's kind of nice.
Now there is no maximumout-of-pocket with supplements,
but supplements carry a higherprice per month.
The benefits are the same.
(11:48):
I'm on a supplement.
I was on an Advantage plan forthree months and when I first
got a Medicare, my own personalreasons that I needed some stuff
done that only Advantage plancovered and I switched to a
supplement and I had lots ofsurgeries and expenses and I
don't pay a dime.
I just pay $225 a month and Idon't pay a dime.
(12:09):
With Advantage plans it's oftenzero a month, $39 a month.
But let me finish my questionsfor you.
In the last year have you spentany days in the hospital
overnight?
No, that's the most expensivecopay on an advanced plan
(12:30):
hospital stays.
Do you have anything like jointreplacement things that might
be happening in the next 12months?
Dennis Day (12:39):
No.
Kevin Anderson (12:40):
Now if we were in Oregon or California, I would
be asking you a lot ofquestions about your family
history.
Washington is unique and inWashington it's one of the rare
states that don't requirepre-existing conditions,
illusions, waiting periods.
Washington does its guaranteeissues.
(13:03):
They want your new plan.
They cover you for everything.
There's no medical questions.
You skip three or four pages ofmedical questions.
You just get your plan and then, if we need to switch you to a
supplement, washington considersAdvantage plans more
comprehensive, although they arenot, but they consider them
more comprehensive because theyhave, most of them, a built-in
(13:25):
formulary and a drug supplement.
You have to get a standalonedrug plan.
So I think what we should talkabout is advantage plans.
So let's switch gears a littlebit.
Let me ask you a few otherquestions, because you mentioned
you're in an HMO right now andabout three, four years ago well
(13:46):
, six, seven years ago PremierBlue Cross and Regents were the
first ones to have PPOs in thestate of Washington that I was
aware of.
Dennis Day (13:54):
Tell us what a PPO is.
It's the.
Kevin Anderson (13:56):
PPO's.
The state of Washington that Iwas aware of Tell us what a PPO
is Preferred ProviderOrganization as opposed to HMO
Health Management Organization.
So with the advanced plans bothare available.
I have to ask you questions tofigure out which would be most
beneficial for you.
Hmos like you're in now has agatekeeper.
You have a primary carephysician that determines oh, I
(14:16):
see you've hurt your foot oryour knee, go see your doctor
and get a referral to apodiatrist.
With an HMO, with a PPO, youjust go to anybody that takes
your health plan, anybody HMO.
The largest network that I'maware of in the state of
(14:36):
Washington is UnitedHealthcare.
On their HMOs in the state ofWashington they have over 90,000
physicians over 90 hospitals,pretty large group and that is
important because they talk toeach other right Right and that
can be frustrating, like youwere sharing earlier.
That's on the HMO.
The PPO has that same group ofphysicians in network, but not
(14:59):
just in Washington, nationwide.
And why that's important.
If you get a special thyroidcondition that you have to go to
Florida and that's the onlyplace you can go for 30 days to
get this taken care of.
You don't want an HMO.
That's not going to cover youPPO, it's very likely they're
going to be a network and thesame with cancer treatments or
the different things that theyoffer, and HMO is going to keep
(15:23):
you locally and if you choose touse one of those you're going
to be paying out of network andhigher co-pays and higher
maximum out-of-pocket.
But typically HMOs have somebenefits that are included at a
less copay.
So homeopathic, chiropracticand acupuncture are three of the
(15:46):
most common.
Are any of those three thingsimportant to you?
Dennis Day (15:51):
Absolutely yes.
Kevin Anderson (15:54):
Which one Do you use?
Acupunctureupuncture natural?
Dennis Day (15:57):
I use the acupuncture and the chiropractor
and when you use theacupuncture.
Kevin Anderson (16:04):
Well, let's stick with chiropractor first.
How many visits a year do youthink you're doing?
Dennis Day (16:10):
when things are bad, it's once a week, but then
things get better, and so let mesay, as far as a year, I might
use them eight to 10 times ayear.
Kevin Anderson (16:22):
Very doable.
That's not enough to make achoice between HMO and PPO.
The reason I say that isacupuncture is covered by
Medicare as long as it'smedically necessary and most
plans will have a copay of $20for that.
If we got you on a plan thatgave you zero premium or zero
copays for the first 12 visits,it's not going to make up for
(16:47):
the $70 or $80 a month increasein premium.
So that was chiropractorAcupuncture.
How many times Is it somethingsimilar?
Dennis Day (16:57):
Yeah, it's more of an as-needed basis.
Usually that's more like fouror five times a year.
I might go once a week for amonth and then not go the rest
of the year.
Kevin Anderson (17:10):
And is dental an important benefit vision.
And is dental an importantbenefit vision.
Dennis Day (17:16):
Yes, they are, and fortunately my wife's plan does
cover both.
What we're trying to do, to behonest with you, is we're trying
to figure out how can we use myMedicare to reduce her costs
that she pays for covering me,and I don't know if that's
possible, but that would be oneof the things we would look for.
Kevin Anderson (17:38):
You're thinking to keep both plans going on,
right, right, okay, and thatwill be fine.
There's a thing that's calledcoordination of benefits that we
have to make sure happen so wecan make that happen.
Medicare likes to be consideredprimary and there is an option
(18:00):
but I'm not going to recommendit and that is to opt out of
Part B.
Just get your A, because thenyou couldn't get dental and
vision and any of these otherbenefits without having Part B.
But a lot of people that stayon employer plans will just get
theirA because there's nomonthly premium related to it.
We'll get to the coordinationof benefits so that you can get
(18:25):
both.
Let's go back to that question.
Dennis Day (18:28):
Just a second here.
I want to understand youcarefully.
If I wanted vision dental,which plan would be?
I need to get Part B?
Is that what you're saying?
Kevin Anderson (18:37):
Yes, you have to .
Dennis Day (18:39):
Okay.
Kevin Anderson (18:39):
Part B is going to.
I delayed my Social Securityfor a year and a half so I paid
quarterly for my Part B.
Now I have it taken out of mySocial Security but you have to
have A and B.
To get any Medicare product youhave to have both.
Dennis Day (18:54):
Okay.
Kevin Anderson (18:57):
It's not required for staying on your
wife's plan, I see.
Dennis Day (19:00):
Okay.
Kevin Anderson (19:00):
How much dental do you have on her plan?
Dennis Day (19:03):
Cleanings are free three, four times a year.
Crowns aren't covered.
There was a lot of stuff wepaid out of pocket for.
I think the maximum we couldhave in a year was $2,000, if I
remember right.
Kevin Anderson (19:17):
Yeah, most plans will pay 80% on a cavity, on a
filling, and 50% on major worklike crowns, called scheduled
benefits.
With UnitedHealthcare, which isthe one I'm going to recommend
to you, as of last year, thewhole $1,500 can get spent 100%
until it's gone.
There's no schedule of benefits, so I would have, when you sit
(19:41):
down with the manager of whoeverit is that you're doing your
dental care, make sure they'rein network too, but sit down
with them and tell them you wantto bill your wife's plan first.
Then you want to bill Medicarebecause you have a $1,500 limit,
because your wife's plan ispaying for office visits,
cleanings, x-rays, exams.
So might as well get that onher plan and save the 1500.
(20:05):
All right, so, um, unitedhealthcare has a ppo plan, so
it's nationwide cost is39 amonth, yeah.
Dennis Day (20:14):
That's pretty good, I can deal with that.
Kevin Anderson (20:16):
Well, when you hear the benefits, it's
fantastic.
Your doctor payments are zero.
You won't pay anything for yourdoctor.
Remember that maximumout-of-pocket we were talking
about?
It's $6,000 on this plan.
Dennis Day (20:29):
Yeah.
Kevin Anderson (20:38):
Your most expensive thing is when you are
in a hospital.
You have to pay for the firstfive days, and I want to say
$350 a day for the first four orfive days.
Then the rest of the calendaryear.
If you go back to the hospital,you don't pay anything for that
.
But your dental is $1,500.
It'll cover everythingcleanings, fillings, crowns,
whatever.
Your vision is 300, and thevision is 300 just for the
frames.
(20:58):
The lenses themselves are free,and that includes bifocal,
trifocal, progressive, whatever.
If the lenses are included inyour plan, you get 300 for the
frames.
Dennis Day (21:11):
Okay.
Kevin Anderson (21:11):
So it gives you.
When I did this, I was on thisplan for three months before I
switched to my supplement.
So you get 300 for the frames.
You'll also get $50 a quarterfor over-the-counter.
Your medical card fromUnitedHealthcare has a magnetic
strip.
You can go to Dollar Store,fred Meyer, safeway, and you can
(21:31):
get over-the-counter thingslike cough drops, which I've
been going through a lot oflately, toothbrushes, toothpaste
, anything over-the-counter thathas an OTC on the ICI tag, but
it's an extra $200 a year Coldremedies, vitamins, national
Network I already said yourdoctors.
It comes with a drug plan.
(21:53):
We'll go through your drugslater.
You get a free eye exam everyyear.
You can join Renew Active forfree with UnitedHealthcare and
that's kind of exciting.
I'm not wearing my Fitbit today, but if you'll do 7,500 steps
three times a week, they'll payyou $10 a month.
The most I've had clients havedone in a year is $250 in visa
(22:17):
gift cards.
You go in for a flu shot, youget $5.
If you have a nurse come outand do a physical in your house,
that could be $25 up to $50.
If there's anythingpreventative there's a list of
about 30 items that arepreventative.
They'll give you points and youcan trade them in.
But health club, it's literallyevery health club I know.
Ymca is the most expensive, 45a month for seniors.
(22:41):
You get it for free and everytime you go swim they'll log you
in and give you points.
Dennis Day (22:46):
Okay, yeah, I know the club that I'm a member of it
has the silver sneakers.
Kevin Anderson (22:52):
I think, it's free for if you're on Medicare
after, uh, an overnight in thehospital, they'll give you 28
home delivered meals followingthat inpatient stay.
Wow, um, the nurse hotline isphenomenal 24 hours a day, seven
days a week.
But the nurse hotline saveslives and it's so simple,
(23:12):
especially with us guys.
We hate going to the doctor, ohyeah, so but I'll call the
nurse hotline.
Now here's your chiropractic.
You get 12 visits per year at aten dollar copay.
Okay, and your acupuncture?
12 visits for ten dollar copay.
I just went through this withour mutual friend.
(23:35):
Massage has to be medicallynecessary.
It has to be coded correctly,because Medicare itself doesn't
cover massage.
So if Medicare doesn't cover it, your advance plan won't either
.
Dennis Day (23:54):
So it has to be medically necessary, so meaning
you have to be referred to by adoctor, your family physician or
a specialist.
Kevin Anderson (24:01):
Your specialist is $35.
Your doctor appointment is zerocopay.
Dennis Day (24:06):
Okay.
Kevin Anderson (24:07):
That's the guts of this program $39 a month,
6,000 maximum out of pocket, andit pays 100%.
And it has a built-in drug plan.
90% of all prescriptions aregeneric.
As long as they're in thegeneric frame, you'll probably
be getting them for free.
Tier 1s are preferred generic.
(24:27):
Tier 2s are $12 a month, but ifyou have it home delivered it's
free.
Dennis Day (24:34):
I did have a question kind of way back in our
earlier early in the podcast.
There you were not on asupplement and then you got on a
supplement because you hadthese surgeries coming up.
Is that?
Are you capable of doing thatat any time in the year?
Kevin Anderson (24:52):
No it has to be an enrollment period.
Dennis Day (24:53):
Okay, any time in the year?
No, it has to be an enrollmentperiod.
Kevin Anderson (24:55):
Okay, and in the state of Washington when you
decide to do it and it'savailable to you to do, there
won't be a it's guaranteedissues.
You won't have medicalquestions.
So you're getting your planJune 1st.
Your first chance opportunitywill be October 15th to change
your plan.
Between October 15th andDecember 7th is the annual
(25:19):
enrollment period.
It'll start January 1st.
Now, since you're on anAdvantage plan, medicare and
this is something new two orthree years ago Medicare has
that's annual.
They'll do an open enrollmentJanuary 1 through March 31st
where you can go from oneadvanced plan to another.
So there's a six-month windownow for advanced plans that
(25:40):
allow you to change to somethingelse.
Now, if you move, that willopen up a 63-day window to
change your plan.
If the company no longer isavailable in your area, you can
change your plans.
If your network changessignificantly, if there's
reasons why Medicare will letyou change plans, but it has to
(26:03):
be a specified reason.
It's called SEP, specialenrollment period and there's
about 15 reasons.
Dennis Day (26:12):
And after that, without that special enrollment
period or after March 31st, youare with your plan.
You can't add anything untilthe next open enrollment, which
would start January 1st.
Kevin Anderson (26:24):
That's correct.
Okay, you could get canceled.
If you don't pay for threemonths, they could cancel you,
but that doesn't open anenrollment period for you
because you've orchestrated it.
Okay, now, if the plan cancelsyou, if you are at a zero
premium plan and they cancelbecause they're moving out of
King County now that opens up a63-day window you can get
(26:45):
another plan without medicalquestions.
Guarantee issue.
Dennis Day (26:47):
Okay, that was another question.
So you're talking about a planfor me in King County, but if I
lived in an adjoining county,the same plan might not be
available, is that?
Kevin Anderson (27:02):
kind of correct no People that live in a list of
10 other counties I see.
So King County, up and down theI-5 corridor down to Lewis.
Then Lewis stands alone, has adifferent book, same plan, but
it'll have a different book anda different number, but it'll be
the same plan.
So for billing purposes in thatarea they use different
(27:26):
third-party administrators forthe billing.
And then you get down toVancouver and Dallas and it's
another one.
And even if he went to Spokaneit'd be the same plan but it'll
be a different plan.
Number One thing, real importantwhen you're first on Medicare,
you have three months you canchange your mind.
Okay, that's what I did.
(27:48):
I did an advantage plan becauseI hadn't been to the dentist in
10 years.
I wanted eyeglasses, I wantedall this.
I wanted hearing aids.
I didn't talk about hearingaids.
I got $7,000 hearing aids from.
Your plan Cost me 1100 bucks.
Wow, phenomenal.
I wanted all that.
So I went on it and threemonths later I put myself on a
supplement so I could starttaking care of all the surgeries
(28:10):
.
Okay, it was cheaper.
Now your plan has an outpatient, which is phenomenal.
Nowadays even kneesreplacements are doing on
outpatient.
You go in and you go home thesame night.
Now I stayed overnight for myshoulder.
But anyway, outpatient is not80% 20%, like it has been this
(28:34):
year.
They changed it on this plan tosliding copay from zero to a
maximum of $325.
So if you can get an outpatient, your shoulder is only going to
cost you 325 dollars well,kevin, can a person do all this
on their own?
Dennis Day (28:52):
I mean, can I go to medicare website and kind of
find what I want and fill outthe whole thing on my own if I
want to?
Kevin Anderson (29:02):
absolutely, you can medicaregov.
You can do that.
I would recommend that you don'twhether you're talking to me or
my wife or some other personthat you find that that's been
at this a long time.
You're going to get insightsand you're going to get extra
things that that, if you need aspecialist doctor, all you have
to do is call Kevin.
(29:22):
I'm going to get on thecomputer and find them for you.
Even though I'm just anenrollment agent, I can do that.
You have billing issues?
I'll I can get help you withthat if you do it on your own.
And a lot of people fall forthe tv ads.
Oh my gosh, it's so sad.
Well, you'll never.
If you have a problem, you gotto call the tv yeah good luck
(29:45):
with that.
So, but you can.
You can enroll all on your own,do all the research on your own
, but I I think that if you findsomebody with at least 10 years
of experience, it's worth it.
It doesn't cost you anythingright?
Dennis Day (29:58):
it doesn't, it's free, it's worth it.
I mean just talking to you now.
I'm kind of my head is spinningabout.
I'm sorry.
It's okay, but this is whateverybody's going through.
There's so many different plansand then each plan has
different pros and cons, and itreally is a good idea to talk to
(30:20):
somebody who knows what they'redoing so you can get the plan
that is the least expensive andthe most effective for you it's
complicated it is and it's avery steep learning curve.
Kevin Anderson (30:34):
It's and you're making a decision that's going
to be your decision for 12months.
You know you don't want to findout later.
Oh man, I didn't think that Ididn't know to ask that one,
right, I didn't know to do thisGosh.
Dennis Day (30:51):
Kevin, I'm so glad you're here.
If somebody is listening andsays, hey, how do I talk to
Kevin?
What do they do?
Kevin Anderson (31:02):
You can call me three, six, zero, three, five,
five, six, five, five.
What do they do?
You can call me 360-355-6555.
That's my cell.
Or you can call you and you cangive them the phone number.
I'm not.
If they send me a text or email, I'm not allowed to call them.
Anyone calling you once you'vehit the age 65 with a Medicare
(31:23):
offer, they're breaking the law.
For me to call you, I have tohave it in writing 48 hours
ahead of time.
You and I did that with thescope of appointment.
We did electronically to giveme permission to talk to you.
I have to have it in writingand then it's good for 90 days.
Dennis Day (31:41):
Anyone calls you they're breaking the law that.
Kevin Anderson (31:44):
Seniors protect from all the scalpers and sharks
out there.
Yeah, oh, they're all over TV.
Just I called and checked myzip code to see if I can have
the benefits.
Well, those benefits arelistening on that TV could be a
little piece of a plan.
There's no one plan that hasall the things you see on TV.
(32:04):
Okay, yeah, and then the nextthing they'll do is they'll wait
a day and call you and get afuneral plan put together.
They'll call you for your autoinsurance, your house insurance
I'm I'm really happy to talk toyou about this.
Dennis Day (32:18):
I can change in a few months.
In six months I'd be able tochange if it's not working out,
and so I I got a trial period I,so I couldn't see how this
works for six months well,that's it, kevin, any any last
words, no, so people have tocall you.
That's right, and then do youhave to do the form that you
(32:40):
sent me?
Kevin Anderson (32:41):
after the phone call if it's an incoming call no
, I don't have to do the form.
I have to have the form for anoutgoing.
Dennis Day (32:48):
Great.
Kevin Anderson (32:48):
Yeah, and we can do.
We can meet at the office.
I can come out to the house.
If I go to the house, I alwaysbring my wife with me.
We can meet in person.
Some people aren't able to doZoom meetings like this, but we
can do it over Zoom as well.
So I Zoomed in and picked whatI would pick for me if I was in
your shoes, and that takes aconversation, though, right?
Dennis Day (33:12):
Yes, it does.
Kevin Anderson (33:13):
Yes, it does.
Dennis Day (33:14):
Okay, kevin, we're going to get a good start on
this.
Thank you so much for helpingme out and we'll talk to you
soon.
Kevin Anderson (33:22):
All right, dennis, take care.
Bye-bye.
Dennis Day (33:26):
And that's it for getting your edge out of right
size your home and life podcast.
I'm your host, Dennis Day.
Thanks for listening, as always.
Have a great day, Bye-bye.
Good day everyone.
This is Dennis Day with Gettingyour Edge how to Right Size
your Home and Life podcast, andI'm here with Kevin Anderson,
who is a Medicare specialist,and we're going to discuss how
to sign up for Medicare and getyour plan chosen.
I am one month away fromturning 65.
(00:23):
Uh-oh, am I in trouble?
Kevin Anderson (00:25):
Kevin, you're not in trouble at all.
No, you're perfect timing,perfect.
Dennis Day (00:30):
Because everybody keeps saying oh Dennis, you were
supposed to do that months ago.
Kevin Anderson (00:36):
Kevin said it was okay.
Apologize for the coughing.
I'm getting over bronchitis.
I'm getting over bronchitis,but you have an open window
through Medicare that startedthree months prior to your
birthday month and extendsanother three months after your
birthday month.
So as long as you get it donewithin that time frame
(00:57):
preferably, like you are yourbirthday is in June.
So what we zero in on your plantoday and figure out what might
be the best for yourconsideration it'll actually
start June 1st, so you won'thave any gaps.
You won't have just originalMedicare to rely on, which will
start on June 1st for you.
So did you get your Medicarecard in hand, Dennis?
Dennis Day (01:19):
No, I haven't signed up for the Medicare card.
I got my social securityaccount created.
Ssagov Created that fullaccount password, lots of checks
to avoid fraud and so forth,and then the next step was sign
up for Medicare.
Before we go farther, Kevin,can you tell our audience who
(01:41):
you are and what you do?
Kevin Anderson (01:42):
Oh sure, I'm Kevin Anderson.
I'm out of Long Beach,washington.
I work up and down the I-5corridor in Washington for
Medicare.
I'm a premier gold agent withone of the carriers,
unitedhealthcare, and I've beendoing insurance since 1997.
The last 13 and 14 years, 100%Medicare.
(02:06):
So my name is on an insuranceoffice in Longview, washington,
on the door.
The gals in there do everythingthat they need to do for other
insurances.
I only do Medicare.
It's quite the beast thatCongress has built and there's a
lot of ins and outs and a lotof changes all the time, every
year in fact.
(02:27):
So what I would suggest forthose listening is 90 days or 89
days prior to your first day ofyour birthday month.
Do what Dennis did go to ssagovor myssagov and make sure that
you've set up an account.
You can decide whether you'regoing to take social security or
not at 65, or you might extendit out, like I did, to full
(02:51):
social security.
Age In my case was 66 and ahalf.
More importantly, this is aboutMedicare.
So most of the time I don't knowwhat percentage, 90% of the
time Medicare is pretty good atkeeping track of you and they
know when your Part A and yourPart B will start and they'll
correspond with you.
They won't talk to you 91 daysprior to the first day of your
(03:15):
birthday month.
You have to wait until you'rewithin that window and I
recommend those that arelistening do that right away, as
soon as you're eligible,because it could take them
several weeks Now in Dennis'scase, when we're done here, I'll
actually look him up and see ifMedicare has kept good tabs on
him.
What I mean by good tabs iswhen we move.
(03:37):
If you've moved in the lastfive years four or five years
Medicare may not have yourcurrent address to send you
correspondence, so that's whereyou could fall into the crap.
Dennis Day (03:48):
I've been at my place for I don't know since 19
uh 1999, man 1998 oh, you'velived in the same address.
Kevin Anderson (03:59):
Yeah, wow, that's, that's fantastic.
You're in real estate.
How often does the averageperson change residence?
Dennis Day (04:08):
I used to be every seven years.
Now it's hard to say.
For some people it's sooner andfor a lot of people it's a
little longer now becausethey've been living in those.
Most of the baby boomers havebeen living in this one house
for a great deal of time.
Kevin Anderson (04:25):
And with interest rates several years ago
down in the 3% range.
And what are they today?
Seven?
Dennis Day (04:31):
Yeah, you're going to look at a seven or so plus or
minus.
Kevin Anderson (04:37):
Back to Medicare .
So we'll check when we're donehere, once we zero in on which
plan is going to be best for you, dennis, we'll check.
There might be some other stepsthat we'll have to do.
So that's why I encourageeveryone, 90 days prior you can
even call 1-800-MEDICARE ifyou'd rather do it on the phone,
but be prepared to wait a while.
And with myssagov you can alsoset up a phone interview and
(05:00):
they'll do it about a week outand that's kind of convenient
also.
So Medicare A and B those of usthat have worked at least 10
years, we receive our Medicare Aand B at age 65 or sooner.
With a two-year history ofsocial security SSI, income,
disability kinds of things fortwo years.
(05:20):
You can actually get it earlierand I have clients in there.
I have one client in his 30s.
He's in his 30s.
I have others down in the below20 years old that are on
Medicare.
So, but typically it's when youturn 65.
Part A is hospitalization.
In very general I'm only goingto spend two minutes on this
(05:41):
Hospitalization.
The first day in a hospital onoriginal Medicare you'll pay a
$1,600 deductible.
Then there's a per day charge.
You could pay up to $80,000 or$90,000 on your Part A if you
don't have any other coverage tohelp with the gaps.
Part B pays your doctor, yourtests, your MRI, your CAT scans,
and I had a slug of those thisyear.
That's why Medicare Part B pays80%.
(06:08):
You pay 20%.
So it's a good idea to haveanother supplemental plan of
some sort to pick up that.
That can be expensive.
So I'm going to ask you somequestions, dennis.
Congress has delineated thebenefits of what's called
Medigap policies or supplements.
Those are the same no matterwhat company you go to.
(06:29):
But that's one beast andthere's reasons why 5% or so of
people choose that.
The other one is Advantageplans.
Those are administered by athird party.
Those are never the samebenefits between companies and
all of the ones that do havebuilt-in drug plans.
The formularies are alldifferent.
So it's really important to getan agent, find somebody you
(06:52):
trust that can plug in yourprescriptions.
Make sure that the formulary inthe Advantage plan is the best
for you, my wife and I.
My wife does Medicare as well.
Several years back we had awoman whose drugs were $20,000 a
year.
Wow, now that's impossiblebecause Congress is trying to
(07:14):
get rid of for the last severalyears, that awful thing called a
donut hole.
So now, once you've paid inlike $7,000 or whatever it
actually is, at the moment itpays 100%, so you can't get to
20,000 anymore, but anyway.
So let me ask some generalquestions.
You're up in King County, right?
Dennis Day (07:34):
Yes.
Kevin Anderson (07:35):
So do you stay in King County physically at
least six months a year?
12 months a year?
Yes, okay, if you are asnowbird and are gone more than
six months a year, you couldstill buy an advantage plan and
probably won't have any issues.
The requirement is that youspend six months a year in your
county of residence A companylike Humana or Unite Healthcare.
(08:00):
If you have a seven or $800,000bill, they're going to look
into you.
They find out you're cruisingthe world 10 months a year.
They're going to refund yourpremiums and not pay your bill.
Wow, so you want to just followthe rules and you said yes, so
you qualify for an advantageplan.
I'm assuming you're on amedical plan now.
Perhaps your work?
Dennis Day (08:20):
Yes, my wife has a pretty good benefits.
She works for a local schooldistrict and she covers me.
I don't know how much she paysadditional for my coverage, but
yeah, I have a good plan.
Kevin Anderson (08:36):
So okay, On the plan you're on now, what kind of
benefits do you really enjoy?
What is important to you on theplan that you're on now?
Dennis Day (08:45):
The plan I have is kind of an HMO, so I like the
fact that the drugs are fairlyinexpensive.
I do have low deductibles.
January 1st I start over andI'll be required to keep paying
until I pay a certain amount andI don't remember how much it is
(09:06):
.
Then everything is covered,with the exception of co-pays
and so forth that I like.
My co-pay is $20.
In past years it's been $15.
I like the convenience of awhole network, meaning that I go
to a specialist that's withinthis HMO group right.
(09:30):
Whereas my mother who's onHumana, she's part of a group
but she can go to all theseother different places, but I
found that they don'tcommunicate.
So when she goes to aspecialist, that's great, she
gets help, blah, blah, blah, butnothing goes to her regular
doctor, unless I make thathappen for her, et cetera Got it
(09:53):
.
So within this I'm within onesystem and all my records kind
of housed in one spot thateverybody within that system has
access.
I really like that.
Kevin Anderson (10:04):
I understand and I'm hearing you.
Let me set everyone's mind atease.
Any advantage plan that I'maware of, at least in the state
of Washington, oregon and Idaho,the states that I'm licensed in
have no deductibles.
There is no deductible.
There are copays, but what youwere just sharing is every
(10:24):
January you have to start bypaying off your deductible
before you can get to yourco-pays.
That doesn't exist withAdvantage plans.
Very few supplements.
It has to be a high deductible.
Well, fs aren't availableanymore, but G plans.
There are high deductible Gsthat will have a deductible
(10:45):
1,800 or whatever it is per year.
But overall most Medicare plansdo not carry deductible.
What they do have is what'scalled maximum out-of-pocket,
mooc.
Your maximum out-of-pocketannually changes, not with
supplements.
There is no maximum.
(11:05):
You could charge $2 million andit's going to pay it all.
With an advanced plan you havea maximum out-of-pocket.
So if your co-pays you don'thave a deductible.
But if your co-pays ever reacha certain number and it
typically ranges between $4,000and $6,500, depending on the
plan but say you reach $6,000,the rest of the year 100% of
(11:27):
your medical is covered.
So it's not deductible.
That's a sum, your total sum ofyour co -pays.
So that's kind of nice.
Now there is no maximumout-of-pocket with supplements,
but supplements carry a higherprice per month.
The benefits are the same.
(11:48):
I'm on a supplement.
I was on an Advantage plan forthree months and when I first
got a Medicare, my own personalreasons that I needed some stuff
done that only Advantage plancovered and I switched to a
supplement and I had lots ofsurgeries and expenses and I
don't pay a dime.
I just pay $225 a month and Idon't pay a dime.
(12:09):
With Advantage plans it's oftenzero a month, $39 a month.
But let me finish my questionsfor you.
In the last year have you spentany days in the hospital
overnight?
No, that's the most expensivecopay on an advanced plan
(12:30):
hospital stays.
Do you have anything like jointreplacement things that might
be happening in the next 12months?
Dennis Day (12:39):
No.
Kevin Anderson (12:40):
Now if we were in Oregon or California, I would
be asking you a lot ofquestions about your family
history.
Washington is unique and inWashington it's one of the rare
states that don't requirepre-existing conditions,
illusions, waiting periods.
Washington does its guaranteeissues.
(13:03):
They want your new plan.
They cover you for everything.
There's no medical questions.
You skip three or four pages ofmedical questions.
You just get your plan and then, if we need to switch you to a
supplement, washington considersAdvantage plans more
comprehensive, although they arenot, but they consider them
more comprehensive because theyhave, most of them, a built-in
(13:25):
formulary and a drug supplement.
You have to get a standalonedrug plan.
So I think what we should talkabout is advantage plans.
So let's switch gears a littlebit.
Let me ask you a few otherquestions, because you mentioned
you're in an HMO right now andabout three, four years ago well
(13:46):
, six, seven years ago PremierBlue Cross and Regents were the
first ones to have PPOs in thestate of Washington that I was
aware of.
Dennis Day (13:54):
Tell us what a PPO is.
It's the.
Kevin Anderson (13:56):
PPO's.
The state of Washington that Iwas aware of Tell us what a PPO
is Preferred ProviderOrganization as opposed to HMO
Health Management Organization.
So with the advanced plans bothare available.
I have to ask you questions tofigure out which would be most
beneficial for you.
Hmos like you're in now has agatekeeper.
You have a primary carephysician that determines oh, I
(14:16):
see you've hurt your foot oryour knee, go see your doctor
and get a referral to apodiatrist.
With an HMO, with a PPO, youjust go to anybody that takes
your health plan, anybody HMO.
The largest network that I'maware of in the state of
(14:36):
Washington is UnitedHealthcare.
On their HMOs in the state ofWashington they have over 90,000
physicians over 90 hospitals,pretty large group and that is
important because they talk toeach other right Right and that
can be frustrating, like youwere sharing earlier.
That's on the HMO.
The PPO has that same group ofphysicians in network, but not
(14:59):
just in Washington, nationwide.
And why that's important.
If you get a special thyroidcondition that you have to go to
Florida and that's the onlyplace you can go for 30 days to
get this taken care of.
You don't want an HMO.
That's not going to cover youPPO, it's very likely they're
going to be a network and thesame with cancer treatments or
the different things that theyoffer, and HMO is going to keep
(15:23):
you locally and if you choose touse one of those you're going
to be paying out of network andhigher co-pays and higher
maximum out-of-pocket.
But typically HMOs have somebenefits that are included at a
less copay.
So homeopathic, chiropracticand acupuncture are three of the
(15:46):
most common.
Are any of those three thingsimportant to you?
Dennis Day (15:51):
Absolutely yes.
Kevin Anderson (15:54):
Which one Do you use?
Acupunctureupuncture natural?
Dennis Day (15:57):
I use the acupuncture and the chiropractor
and when you use theacupuncture.
Kevin Anderson (16:04):
Well, let's stick with chiropractor first.
How many visits a year do youthink you're doing?
Dennis Day (16:10):
when things are bad, it's once a week, but then
things get better, and so let mesay, as far as a year, I might
use them eight to 10 times ayear.
Kevin Anderson (16:22):
Very doable.
That's not enough to make achoice between HMO and PPO.
The reason I say that isacupuncture is covered by
Medicare as long as it'smedically necessary and most
plans will have a copay of $20for that.
If we got you on a plan thatgave you zero premium or zero
copays for the first 12 visits,it's not going to make up for
(16:47):
the $70 or $80 a month increasein premium.
So that was chiropractorAcupuncture.
How many times Is it somethingsimilar?
Dennis Day (16:57):
Yeah, it's more of an as-needed basis.
Usually that's more like fouror five times a year.
I might go once a week for amonth and then not go the rest
of the year.
Kevin Anderson (17:10):
And is dental an important benefit vision.
And is dental an importantbenefit vision.
Dennis Day (17:16):
Yes, they are, and fortunately my wife's plan does
cover both.
What we're trying to do, to behonest with you, is we're trying
to figure out how can we use myMedicare to reduce her costs
that she pays for covering me,and I don't know if that's
possible, but that would be oneof the things we would look for.
Kevin Anderson (17:38):
You're thinking to keep both plans going on,
right, right, okay, and thatwill be fine.
There's a thing that's calledcoordination of benefits that we
have to make sure happen so wecan make that happen.
Medicare likes to be consideredprimary and there is an option
(18:00):
but I'm not going to recommendit and that is to opt out of
Part B.
Just get your A, because thenyou couldn't get dental and
vision and any of these otherbenefits without having Part B.
But a lot of people that stayon employer plans will just get
theirA because there's nomonthly premium related to it.
We'll get to the coordinationof benefits so that you can get
(18:25):
both.
Let's go back to that question.
Dennis Day (18:28):
Just a second here.
I want to understand youcarefully.
If I wanted vision dental,which plan would be?
I need to get Part B?
Is that what you're saying?
Kevin Anderson (18:37):
Yes, you have to .
Dennis Day (18:39):
Okay.
Kevin Anderson (18:39):
Part B is going to.
I delayed my Social Securityfor a year and a half so I paid
quarterly for my Part B.
Now I have it taken out of mySocial Security but you have to
have A and B.
To get any Medicare product youhave to have both.
Dennis Day (18:54):
Okay.
Kevin Anderson (18:57):
It's not required for staying on your
wife's plan, I see.
Dennis Day (19:00):
Okay.
Kevin Anderson (19:00):
How much dental do you have on her plan?
Dennis Day (19:03):
Cleanings are free three, four times a year.
Crowns aren't covered.
There was a lot of stuff wepaid out of pocket for.
I think the maximum we couldhave in a year was $2,000, if I
remember right.
Kevin Anderson (19:17):
Yeah, most plans will pay 80% on a cavity, on a
filling, and 50% on major worklike crowns, called scheduled
benefits.
With UnitedHealthcare, which isthe one I'm going to recommend
to you, as of last year, thewhole $1,500 can get spent 100%
until it's gone.
There's no schedule of benefits, so I would have, when you sit
(19:41):
down with the manager of whoeverit is that you're doing your
dental care, make sure they'rein network too, but sit down
with them and tell them you wantto bill your wife's plan first.
Then you want to bill Medicarebecause you have a $1,500 limit,
because your wife's plan ispaying for office visits,
cleanings, x-rays, exams.
So might as well get that onher plan and save the 1500.
(20:05):
All right, so, um, unitedhealthcare has a ppo plan, so
it's nationwide cost is39 amonth, yeah.
Dennis Day (20:14):
That's pretty good, I can deal with that.
Kevin Anderson (20:16):
Well, when you hear the benefits, it's
fantastic.
Your doctor payments are zero.
You won't pay anything for yourdoctor.
Remember that maximumout-of-pocket we were talking
about?
It's $6,000 on this plan.
Dennis Day (20:29):
Yeah.
Kevin Anderson (20:38):
Your most expensive thing is when you are
in a hospital.
You have to pay for the firstfive days, and I want to say
$350 a day for the first four orfive days.
Then the rest of the calendaryear.
If you go back to the hospital,you don't pay anything for that
.
But your dental is $1,500.
It'll cover everythingcleanings, fillings, crowns,
whatever.
Your vision is 300, and thevision is 300 just for the
frames.
(20:58):
The lenses themselves are free,and that includes bifocal,
trifocal, progressive, whatever.
If the lenses are included inyour plan, you get 300 for the
frames.
Dennis Day (21:11):
Okay.
Kevin Anderson (21:11):
So it gives you.
When I did this, I was on thisplan for three months before I
switched to my supplement.
So you get 300 for the frames.
You'll also get $50 a quarterfor over-the-counter.
Your medical card fromUnitedHealthcare has a magnetic
strip.
You can go to Dollar Store,fred Meyer, safeway, and you can
(21:31):
get over-the-counter thingslike cough drops, which I've
been going through a lot oflately, toothbrushes, toothpaste
, anything over-the-counter thathas an OTC on the ICI tag, but
it's an extra $200 a year Coldremedies, vitamins, national
Network I already said yourdoctors.
It comes with a drug plan.
(21:53):
We'll go through your drugslater.
You get a free eye exam everyyear.
You can join Renew Active forfree with UnitedHealthcare and
that's kind of exciting.
I'm not wearing my Fitbit today, but if you'll do 7,500 steps
three times a week, they'll payyou $10 a month.
The most I've had clients havedone in a year is $250 in visa
(22:17):
gift cards.
You go in for a flu shot, youget $5.
If you have a nurse come outand do a physical in your house,
that could be $25 up to $50.
If there's anythingpreventative there's a list of
about 30 items that arepreventative.
They'll give you points and youcan trade them in.
But health club, it's literallyevery health club I know.
Ymca is the most expensive, 45a month for seniors.
(22:41):
You get it for free and everytime you go swim they'll log you
in and give you points.
Dennis Day (22:46):
Okay, yeah, I know the club that I'm a member of it
has the silver sneakers.
Kevin Anderson (22:52):
I think, it's free for if you're on Medicare
after, uh, an overnight in thehospital, they'll give you 28
home delivered meals followingthat inpatient stay.
Wow, um, the nurse hotline isphenomenal 24 hours a day, seven
days a week.
But the nurse hotline saveslives and it's so simple,
(23:12):
especially with us guys.
We hate going to the doctor, ohyeah, so but I'll call the
nurse hotline.
Now here's your chiropractic.
You get 12 visits per year at aten dollar copay.
Okay, and your acupuncture?
12 visits for ten dollar copay.
I just went through this withour mutual friend.
(23:35):
Massage has to be medicallynecessary.
It has to be coded correctly,because Medicare itself doesn't
cover massage.
So if Medicare doesn't cover it, your advance plan won't either
.
Dennis Day (23:54):
So it has to be medically necessary, so meaning
you have to be referred to by adoctor, your family physician or
a specialist.
Kevin Anderson (24:01):
Your specialist is $35.
Your doctor appointment is zerocopay.
Dennis Day (24:06):
Okay.
Kevin Anderson (24:07):
That's the guts of this program $39 a month,
6,000 maximum out of pocket, andit pays 100%.
And it has a built-in drug plan.
90% of all prescriptions aregeneric.
As long as they're in thegeneric frame, you'll probably
be getting them for free.
Tier 1s are preferred generic.
(24:27):
Tier 2s are $12 a month, but ifyou have it home delivered it's
free.
Dennis Day (24:34):
I did have a question kind of way back in our
earlier early in the podcast.
There you were not on asupplement and then you got on a
supplement because you hadthese surgeries coming up.
Is that?
Are you capable of doing thatat any time in the year?
Kevin Anderson (24:52):
No it has to be an enrollment period.
Dennis Day (24:53):
Okay, any time in the year?
No, it has to be an enrollmentperiod.
Kevin Anderson (24:55):
Okay, and in the state of Washington when you
decide to do it and it'savailable to you to do, there
won't be a it's guaranteedissues.
You won't have medicalquestions.
So you're getting your planJune 1st.
Your first chance opportunitywill be October 15th to change
your plan.
Between October 15th andDecember 7th is the annual
(25:19):
enrollment period.
It'll start January 1st.
Now, since you're on anAdvantage plan, medicare and
this is something new two orthree years ago Medicare has
that's annual.
They'll do an open enrollmentJanuary 1 through March 31st
where you can go from oneadvanced plan to another.
So there's a six-month windownow for advanced plans that
(25:40):
allow you to change to somethingelse.
Now, if you move, that willopen up a 63-day window to
change your plan.
If the company no longer isavailable in your area, you can
change your plans.
If your network changessignificantly, if there's
reasons why Medicare will letyou change plans, but it has to
(26:03):
be a specified reason.
It's called SEP, specialenrollment period and there's
about 15 reasons.
Dennis Day (26:12):
And after that, without that special enrollment
period or after March 31st, youare with your plan.
You can't add anything untilthe next open enrollment, which
would start January 1st.
Kevin Anderson (26:24):
That's correct.
Okay, you could get canceled.
If you don't pay for threemonths, they could cancel you,
but that doesn't open anenrollment period for you
because you've orchestrated it.
Okay, now, if the plan cancelsyou, if you are at a zero
premium plan and they cancelbecause they're moving out of
King County now that opens up a63-day window you can get
(26:45):
another plan without medicalquestions.
Guarantee issue.
Dennis Day (26:47):
Okay, that was another question.
So you're talking about a planfor me in King County, but if I
lived in an adjoining county,the same plan might not be
available, is that?
Kevin Anderson (27:02):
kind of correct no People that live in a list of
10 other counties I see.
So King County, up and down theI-5 corridor down to Lewis.
Then Lewis stands alone, has adifferent book, same plan, but
it'll have a different book anda different number, but it'll be
the same plan.
So for billing purposes in thatarea they use different
(27:26):
third-party administrators forthe billing.
And then you get down toVancouver and Dallas and it's
another one.
And even if he went to Spokaneit'd be the same plan but it'll
be a different plan.
Number One thing, real importantwhen you're first on Medicare,
you have three months you canchange your mind.
Okay, that's what I did.
(27:48):
I did an advantage plan becauseI hadn't been to the dentist in
10 years.
I wanted eyeglasses, I wantedall this.
I wanted hearing aids.
I didn't talk about hearingaids.
I got $7,000 hearing aids from.
Your plan Cost me 1100 bucks.
Wow, phenomenal.
I wanted all that.
So I went on it and threemonths later I put myself on a
supplement so I could starttaking care of all the surgeries
(28:10):
.
Okay, it was cheaper.
Now your plan has an outpatient, which is phenomenal.
Nowadays even kneesreplacements are doing on
outpatient.
You go in and you go home thesame night.
Now I stayed overnight for myshoulder.
But anyway, outpatient is not80% 20%, like it has been this
(28:34):
year.
They changed it on this plan tosliding copay from zero to a
maximum of $325.
So if you can get an outpatient, your shoulder is only going to
cost you 325 dollars well,kevin, can a person do all this
on their own?
Dennis Day (28:52):
I mean, can I go to medicare website and kind of
find what I want and fill outthe whole thing on my own if I
want to?
Kevin Anderson (29:02):
absolutely, you can medicaregov.
You can do that.
I would recommend that you don'twhether you're talking to me or
my wife or some other personthat you find that that's been
at this a long time.
You're going to get insightsand you're going to get extra
things that that, if you need aspecialist doctor, all you have
to do is call Kevin.
(29:22):
I'm going to get on thecomputer and find them for you.
Even though I'm just anenrollment agent, I can do that.
You have billing issues?
I'll I can get help you withthat if you do it on your own.
And a lot of people fall forthe tv ads.
Oh my gosh, it's so sad.
Well, you'll never.
If you have a problem, you gotto call the tv yeah good luck
(29:45):
with that.
So, but you can.
You can enroll all on your own,do all the research on your own
, but I I think that if you findsomebody with at least 10 years
of experience, it's worth it.
It doesn't cost you anythingright?
Dennis Day (29:58):
it doesn't, it's free, it's worth it.
I mean just talking to you now.
I'm kind of my head is spinningabout.
I'm sorry.
It's okay, but this is whateverybody's going through.
There's so many different plansand then each plan has
different pros and cons, and itreally is a good idea to talk to
(30:20):
somebody who knows what they'redoing so you can get the plan
that is the least expensive andthe most effective for you it's
complicated it is and it's avery steep learning curve.
Kevin Anderson (30:34):
It's and you're making a decision that's going
to be your decision for 12months.
You know you don't want to findout later.
Oh man, I didn't think that Ididn't know to ask that one,
right, I didn't know to do thisGosh.
Dennis Day (30:51):
Kevin, I'm so glad you're here.
If somebody is listening andsays, hey, how do I talk to
Kevin?
What do they do?
Kevin Anderson (31:02):
You can call me three, six, zero, three, five,
five, six, five, five.
What do they do?
You can call me 360-355-6555.
That's my cell.
Or you can call you and you cangive them the phone number.
I'm not.
If they send me a text or email, I'm not allowed to call them.
Anyone calling you once you'vehit the age 65 with a Medicare
(31:23):
offer, they're breaking the law.
For me to call you, I have tohave it in writing 48 hours
ahead of time.
You and I did that with thescope of appointment.
We did electronically to giveme permission to talk to you.
I have to have it in writingand then it's good for 90 days.
Dennis Day (31:41):
Anyone calls you they're breaking the law that.
Kevin Anderson (31:44):
Seniors protect from all the scalpers and sharks
out there.
Yeah, oh, they're all over TV.
Just I called and checked myzip code to see if I can have
the benefits.
Well, those benefits arelistening on that TV could be a
little piece of a plan.
There's no one plan that hasall the things you see on TV.
(32:04):
Okay, yeah, and then the nextthing they'll do is they'll wait
a day and call you and get afuneral plan put together.
They'll call you for your autoinsurance, your house insurance
I'm I'm really happy to talk toyou about this.
Dennis Day (32:18):
I can change in a few months.
In six months I'd be able tochange if it's not working out,
and so I I got a trial period I,so I couldn't see how this
works for six months well,that's it, kevin, any any last
words, no, so people have tocall you.
That's right, and then do youhave to do the form that you
(32:40):
sent me?
Kevin Anderson (32:41):
after the phone call if it's an incoming call no
, I don't have to do the form.
I have to have the form for anoutgoing.
Dennis Day (32:48):
Great.
Kevin Anderson (32:48):
Yeah, and we can do.
We can meet at the office.
I can come out to the house.
If I go to the house, I alwaysbring my wife with me.
We can meet in person.
Some people aren't able to doZoom meetings like this, but we
can do it over Zoom as well.
So I Zoomed in and picked whatI would pick for me if I was in
your shoes, and that takes aconversation, though, right?
Dennis Day (33:12):
Yes, it does.
Kevin Anderson (33:13):
Yes, it does.
Dennis Day (33:14):
Okay, kevin, we're going to get a good start on
this.
Thank you so much for helpingme out and we'll talk to you
soon.
Kevin Anderson (33:22):
All right, dennis, take care.
Bye-bye.
Dennis Day (33:26):
And that's it for getting your edge out of right
size your home and life podcast.
I'm your host, Dennis Day.
Thanks for listening, as always.
Have a great day, Bye-bye.
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