December 16, 2024 • 28 mins
Unlock the secrets to navigating the latest Medicare changes with the expert guidance of Dennis Day, Judy Gratton, and our special guest, Kevin Anderson. Prepare to be informed about the significant transformations coming in 2024 and 2025, such as the dissolution of current Advantage and drug plans and the exciting introduction of new companies into the Washington market. The Inflation Reduction Act has paved the way for the elimination of the Medicare "donut hole," a move set to ease medication costs for seniors. We'll provide clarity on premiums, deductibles, and co-pays, ensuring that you are well-equipped to manage your healthcare budget effectively. This episode is your ticket to understanding the financial landscape of your healthcare options.
As we tackle the complexities of Medicare Advantage plans, Kevin Anderson shares why partnering with a Medicare broker can be a game-changer in finding the right plan without additional charges. We'll discuss the open enrollment period, potential pitfalls like scams, and the critical importance of reviewing your plan annually. Learn how companies like UnitedHealthcare are navigating financial constraints by adjusting benefits and explore why connecting with reputable professionals is essential for safeguarding your healthcare choices. Empower yourself with the knowledge to avoid unexpected challenges and make confident decisions about your healthcare needs.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Welcome back everyone .
This is Dennis Day.
With Getting your Edge Out ofRight Signs, your home and life
podcast, We've got a veryinformative show about Medicare.
Before I get going, I want tointroduce our co-host, Judy
Gratton.
Speaker 2 (00:15):
Hi Dennis.
Speaker 1 (00:16):
Hi, jay.
Our guest is Kevin Anderson.
Has been working Medicare forthe past 12 years, enrolled over
800 people.
Kevin has a sets you apart froma regular Medicare agent, much
more informative and helpfulthan the 1-800 numbers, kevin,
(00:36):
that's for sure.
Why, kevin?
What's the difference betweenyou and other brokers?
Speaker 3 (00:42):
One of the key things this year instead of being an
adaptive agent for one company,we found it necessary to become
brokers.
I'm appointed with fivecompanies in your area.
I can write 38 plans.
I'm not a captive, so we havethe freedom to find the perfect
plan.
Most common thing I hear is Iwant the same plan you gave my
(01:06):
best friend and I said there'sabout a one in 25 chance it
happened.
But let me ask you somequestions.
We want the best plan for him,but it wasn't the same as his
friend.
Being a broker gives us thefreedom to find the best plan.
Make sure networks areappropriate for the individual,
and that's why I'm good at whatI do.
Speaker 2 (01:28):
Kevin has been our broker for two years, I think,
or is it three.
This year everything changed.
I had Kevin up before.
It's important for people tounderstand the changes this year
and how it could affectMentioned me, Kevin People who
want to change plan.
I want the.
When they saw what was, theydidn't want it.
That was me.
Speaker 3 (01:49):
No, you weren't alone .
I had a couple of those today.
Speaker 1 (01:53):
What are the key changes from 2024 to 2025 in
Medicare and how will theyimpact seniors?
Speaker 3 (02:03):
It is every advantage plan drug plan will choose to
exist December 31st why plansare being dissolved because of
changes in Medicare.
Many people won't be awareuntil January 1st that they've
reverted back to simple A and BMedicare without a supplement or
Advantage plan.
Several companies have leftthis.
(02:25):
Many counties in Washington,well-known companies leaving
permanently, starting in January.
Let's see if I can do it in anutshell without making two-hour
Medicare seminars.
Speaker 2 (02:38):
Okay.
Speaker 3 (02:39):
Because of companies' counties, the big void.
At least two companies havecome into Washington for the
first time.
Other states, not onlyWashington, but in every single
county they're the only Medicarecompanies in every county
Brings challenges toestablishing networks.
(03:00):
Here is big in Oregon, but thisis their first time in
Washington.
It's a scary thing.
Big company leaving inWashington.
69,000 people will wake upJanuary 1st without a plan if
they didn't do anything.
Those blooms and people can'tenroll in a plan.
It's unfortunate, but I'lltouch on more of this as we go.
Speaker 2 (03:21):
Why were there changes in Medicare happened and
what are the goals intended tobe achieved by these changes?
Speaker 3 (03:29):
Judy, that's a good question and gets to the heart
of the matter.
The big news is that the donuthole will cease to exist
starting in January.
Congress has been working onshrinking the donut hole to help
seniors.
Congress has been working onshrinking the donor role to help
seniors In 2022, presidentBiden's son in the inflation
(03:49):
reduction and eliminating therole Huge.
My wife and I both do Medicareand we've had people with drug
lists who paid $28,000 a year.
It's a record in the low twentythousand dollars.
Once you and the plan paid fivethousand, not counting premium,
you under the donut hole, thetwenty five percent on a typical
(04:14):
tier three, the free, thecopayment might be 45 bucks.
All of a sudden they're fourand five hundred in the donut
hole hoping to get out next yearonce they've reached $2,000 in
deductibles or co-pays the restof the year.
I applaud President Biden.
Another change is payment planfor prescriptions Starting in
(04:39):
January.
Folks that spend $24,000 a yearin drugs, that's $10,000 a month
.
After January.
The drugs will be free afterthat.
Right, not very many of us canspend $10,000 in one month.
Right, we're on fixed budgets.
Seniors have downsized.
They've moved into.
You guys know all about thatmore than I do.
(05:00):
They're on a set budget thatdoesn't grow unless you count
little raises in their socialsecurity.
They're on a set budget.
It doesn't grow unless youcount little raises in their
social security.
They're on a fixed budget.
How do you pay the $2,000?
Medicare says starting nextyear.
What we'll do is we know youwon't have drug payments after
this.
We'll divide it into 12 months.
They won't discount it, soinsert a $2,000 in January.
(05:22):
I don't know what $2,000divided by 12 is.
Judy's super good at math whenshe has a calculator in her hand
.
When she has a calculator inher hand.
Speaker 2 (05:30):
Ah, okay, yes, I do, right here.
It's called my phone.
I'll look.
Speaker 3 (05:34):
It's going to be like $105 in January and each month,
I'm guessing, but that's betterthan $2,000.
And that's brand new and that'sfrom the inflation reduction
net.
So those are good things.
Now, one of the results of thatis that drugs that $166.66.
Speaker 2 (05:55):
There you go.
Speaker 3 (05:56):
Well, it's $8.44.
The whole thing is gearedtowards helping seniors lower
the cost of their medication,and so that's a great thing.
Would you like to know how thepremiums and deducted and
co-pays will change?
Speaker 1 (06:12):
Absolutely.
I've been waiting all day forthis.
Speaker 3 (06:15):
Medicare allows drug plans standalone drug plans or
embedded in advantage plans.
They allow a $590 deductible.
That's the max.
Now companies can go with less,but most of the drug plans are
$500.
If we're talking in the $37 to$48 range a month or premium for
(06:40):
a drug plan, they're going tohave to pay the whole $590.
Now, many companies that haveAdvantage plans with the drug
plan, they're going to have topay the whole $590.
Now, many companies that haveAdvantage plans with the drug
plan built in, they said 90% ofprescriptions are generic.
Tiers 1 and 2, they're fine.
Tiers.
Tiers 1 and 2 are generic.
We won't apply a deductible tothat.
We'll just apply a deductiblefor tiers 3 and up.
(07:01):
That's a huge help, right.
And they might say a deductiblefor two years.
Three and up.
That's a huge help, right.
And they might say, dependingon the plan and depending on the
company, instead of $590, we'reonly going to charge $150
deductible.
So that's another good thing.
It's making money on lemonade,because it isn't such a great
thing that people have to paythe deductible where they never
(07:21):
had to do that before.
If you want a standalone drugplan without a deductible, the
cheapest one that I know is $83a month and I haven't enrolled a
single person in it.
Now many people have beenmapped over to that by their
companies because of the planthat they had that went away.
The company is going toautomatically put them in
another drug plan.
(07:42):
But the reason I don't like it$83 a month, remember.
Premiums don't count towardsyour $2,000.
So you get rid of the $590deductible.
You start just paying co-payson your medications but you
don't get credit for that $83 ormore a month.
You don't get a thousand dollarcredit towards a $2,000 max.
It doesn't make any sense in myway of thinking.
(08:05):
Now, in the past it wasimportant because you paid $100
a month or $110 a month for apremium for a drug plan, but
then you had reasonable co-pays.
Now my own drug plan I'm not onan Advantage plan.
There aren't Advantage plans.
In the county that is now mypermanent residence Most overall
(08:25):
as a general term, there's noadvantage plans.
So I have a standalone drugplan.
Mine, if I kept that one, wentup tenfold for January and
included a $590 deductible.
It went from $3.70 a month.
Very few people know about thatdrug plan but I have a great
agent.
(08:45):
My wife put me on that plan andinstead of $3.70 a month
premium they want you to pay $37a month next year.
That's tenfold Now.
The other big change is manyplans I won't say a majority of
them, but pretty close to atleast half the plans now will
have a medical deductible.
(09:07):
That's brand new news to me.
I haven't seen that before inthe state of Washington.
So before your zero copay foryour physician visit, you've got
to meet a $175 deductible orwhatever the deductible is.
Unfortunately, the biggestcompany doesn't do that.
They don't have a medicaldeductible.
So those are some of thechanges that we're going to see.
Speaker 2 (09:30):
That could be really expensive if you're not careful.
Speaker 3 (09:34):
It is and we'll get it to the end on what people can
do if they've made a mistake orthey don't know how to.
For instance, today isWednesday, medicare opener
annual enrollment, and Saturdayat midnight.
We're down to the last threedays Thursday, friday, saturday
and in years past we've hadappointments showing up at
(09:57):
houses on December 7th at 11 pm.
Back then Jen had to do thewhole list.
The case is one at a time.
I forgot the question, just toremind you.
Jen had to do the whole list.
The question is one at a time.
I forgot the question.
I have just to remind you Ihave attention deficit disorder,
so I go down rabbit trails andsometimes I don't make it back.
Speaker 2 (10:14):
I think you have earned that.
It sounds like over the lastfew weeks trying to help people
understand what the best choiceis for them, and I really Kevin
sat down with us with threedifferent plans and explained
the three that he saw for ourparticular needs, and then we
made a decision based on that,but it took a lot of work.
(10:36):
One of the things that I knowhas changed dramatically is
dental, which I'm very much astickler about dental, and so
Kevin had to go hunting to findsomething that worked for us
with dental.
Speaker 3 (10:53):
There's another challenge that doesn't affect
very many people in youraudience, but people that have
Medicare and Medicaid.
That whole arena and that'soutside the scope of this
webinar that little arena ischanging dramatically.
Companies, that one, onecompany has eight dual plans
where before they just had two,an hmo and a ppo, now they have
(11:14):
eight.
Now we have to determineeligibility or and, and then
there's an integrated issuethat's going to come up in the
next few years, where thecompany that gives the dual
plans has to be integrated withMedicaid and a contract with
Medicaid so that they only getbilled once.
Doctors don't have to spend,send part of the bill to one
(11:35):
place and then the other part toMedicaid, so there's a same one
.
Thank you, judy, for thecompliment.
I appreciate it.
Speaker 2 (11:42):
Well, I'm very serious about that and that's
why I wanted to have you back on, so hopefully people hear this
Now.
You mentioned something brieflyabout if they don't have an
open enrollment period, butisn't there a period in the
first part of the year wherethey can still make a change?
Speaker 3 (12:01):
Yes, it's fair.
Just a few years ago it'scalled open enrollment period.
People call the one we're inright now open, but it's annual
enrollment period that goesthrough December 7th.
A-e-p, o and B you're right,judy starts January 1st and goes
to the end of March.
It's only for people withAdvantage plans and I'm glad
(12:23):
Medicare started this a fewyears back.
If you have an Advantage planthat you don't like, or you
signed on to one because youwatched the TV commercial or
whatever and you signed out it'snot what you were hoping for.
In January and February andMarch you can change to any
other Advantage plan guaranteeissue, no waiting periods, no
(12:45):
pre-existing conditions and youcan get the plan that's best for
you.
Now that's really important inthe companies that stayed.
The companies that stayed havesent back.
In the first week in Octoberthey sent annual notification of
change letters to everyone andit said here's your plan for
2024.
(13:06):
Here's the plan we're puttingyou in for 2025.
If we're talking aboutUnitedHealthcare, that's 20 new
Advantage plans, 20 that theyhave for this year.
And so a computer decidedyou're on this certain PPO,
we're going to put you on thisother PPO, yeah, and your
premium is going to jump to $46.
(13:26):
It doesn't come with any dentalanymore or it might include
just cleaning, something likethat and people go, oh okay.
And then I've been called somany times just even today again
and I called and activated mynew car and I didn't have to
come and see you.
Should I cancel my appointment?
No, you shouldn't.
Let's have the appointment andlet's see if that's the best
(13:48):
plan for you, and in a veryshort order we find out it's not
.
But that's perfect.
For those whose companiesstayed Not like regions that
left you have nothing right.
But if that company stayed,whether it's Humana or
UnitedHealthcare I won't mentiona couple of the others.
It's just better not to mentiona couple others.
I don't want to disparageanybody, but for those that
(14:11):
stayed, they mapped over theirclient base to a new plan.
Some companies called it frostblocked them over, so they won't
be without coverage and duringOEB we can change you.
So that brings a lot of hope.
Speaker 2 (14:26):
One point I want to make because I don't think
people understand this but yourservices don't cost them
anything.
Speaker 3 (14:33):
No, and I had 10 appointments today and twice I
was asked this question.
Judy just made a statementabout how much do we owe you?
I just spent two hours withthis.
Do I have to pay you?
No, and it doesn't matter if Ienrolled you a premium of zero,
a plan that costs nothing, or ifI enrolled you in an F plan
(14:55):
supplement that costs $330.
It doesn't matter, I get paidthe same.
The companies pay us and thecompanies have that money
because Medicare pays them toadminister the plan.
So now it's free and everyoneshould utilize an agent or a
broker.
It's very helpful and theydon't make more money
recommending certain plans.
Speaker 2 (15:17):
So, going back to why did all these changes like loss
of dental and different thingswhy?
Speaker 3 (15:25):
Okay, simply, your drugs this year are free after
you pay $8,000.
Next year they're free after$2,000.
Companies have a $6,000 gap.
Right Now everyone makes itinto the normal, but lots more
people are going to make the$2,000.
So how do they build a plan?
(15:46):
They have a certain amount ofmoney for Medicare that they
have to give back 85% inbenefits.
They're allowed 15% forexpenses and employees and
profit ROI.
So they have to make up $6,000.
Now some companies juststripped bare bones the medical
Instead of $25 for a specialist,maybe it's $65, for example,
(16:09):
right Instead of $1,000 fordental.
One company has $250.
And not only is it $250 fordental, it's your total for
dental and vision.
So they stripped down to makeup that $6,000 hole.
Now I don't mean to just talkabout one plan, but the only
company that illustrates whatI'm trying to say the best is
(16:32):
UnitedHealthcare, with 20 newplans.
So they built a plan withcertain kinds of frosting on the
cake.
The cake is the same size.
Medicare is Medicare.
Here's the cake.
Maybe I want less cake and morefrosting.
Maybe I just want a bite ofcake in the middle and lots of
frosting.
Being the auxiliary benefits oralter therapies, like some
(16:53):
people are into naturopath andthe acupuncture.
Some people really enjoychiropractor.
Those are alternative therapies.
There's only three plans inyour county that includes those
things, but then they might nothave over-the-counter, they
might not have glasses.
Some don't even have dental atall or they might only do
cleanings.
(17:14):
And offer a dental say $54 amonth, we'll give you $1,500.
Offer a dental, say $54 a month, we'll give you $1,500.
So pay $600 a year, we'll giveyou $1,500.
Dental which he's alluding tois one plan has $2,500 of dental
and it also has $50 ofover-the-counter.
That's fantastic, but not allplans have that.
(17:36):
And some people have dentures.
People our age, a lot of us,don't have our own teeth.
People with dentures don't needdental coverage.
They get a realignment of theirdentures every five years,
whatever it is.
So why let the plant havedental?
Let me use that money, that$6,000 hole.
Let's use that money forsomething else.
Speaker 2 (17:59):
And that's what you did with us.
You asked us, we gave you alist of our doctors, we did all
the different things and thenyou were able to show us the
plans that best suited our needs.
And I just it's.
I think it's really importantfor people to consider speaking
to you or someone like you to dothis, to make sure that.
Because you said now, werepeople notified if regents
(18:22):
leaves, did they notify peoplethey were going to be gone or
they just don't have anythingcome january 1st surprise?
Speaker 3 (18:29):
people without agents regents oh, regents, I'm sorry
I took my hair is up okay no,they received an annual
notification of change.
That's required.
The problem is most of themthat I've seen are like little
pamphlets made out of browntissue paper.
They look like a refrigeratorwarranty or something that comes
(18:53):
in the box.
People get that and go I don'twant to read all that and they
throw it out.
So they're unaware that thechange is coming, unless a
friend has told them, and I'vehad a lot of people go.
My friend says I'm losing myplan.
Yeah, you got a letter about it.
No, I never got a letter.
Yeah, you did you just didn'tread it.
Speaker 2 (19:09):
I think Jim is the one who read about our plan
changing, and that's when wepicked up the phone.
Poor Kevin.
Speaker 3 (19:44):
Sounds like some of these's the College of
Integration Reduction Act.
There's a 1.9% max that's tiedinto that.
It's one of the things I didn'tlike about it, so I won't name
a company.
There was one company that did$300 million a quarter, I think
it was, and they were operatingon less than 1% profit, and when
(20:04):
the new contracts came out thatthey signed, they could see the
writing on the wall that theybarely survived profitability.
Many companies lost hundreds ofthousands a quarter this year.
They're going to lose theirnext year.
So rather than do that?
Speaker 1 (20:18):
they just what steps.
If somebody's unclear wherethey stand right now, what would
you suggest they do?
Speaker 3 (20:28):
There are a few people less than 1% that are
really good at research andreally good with computers.
A big majority of people ourage Medicare age.
They're a different generation.
They like their flip phone.
They don't know aboutsmartphones.
They don't know about computersvery well.
They can do Facebook usually,but sending a picture and a text
(20:48):
is hard.
But if someone is good atstudying, I recommend
Medicaregov.
Now Medicaregov is greatlyflawed.
There are several plans that weare appointed to do that people
have to qualify for, thataren't even listed in there, and
then many of the benefits areerroneously represented.
Medicaregov but it'll get yourfeet wet and so I suggest to
(21:10):
people to do an hour worth ofstudy.
Start with Medicaregov and plugin your zip code, plug in your
doctors and then play around inthere, see which providers cover
your doctors and then also yourprescriptions.
You should put your formularyin there, see which providers
cover your doctors and then alsoyour prescriptions.
You should put your formularyin there and then talk to a
broker or a Medicare agent,enrollment agent and then you'll
(21:32):
have some knowledge.
Then your questions will bewhat's the difference between
HMO and PPO?
Before you maybe didn't evenknow they existed.
Your questions will be smarter.
Speaker 2 (21:42):
Go ahead.
No, go ahead, you finish,because my question is different
.
Speaker 1 (21:48):
Oh, I'm done.
Speaker 2 (21:50):
Are there people they should avoid?
They could call you.
I hear a lot of advertisementon the radio and television and
whatnot for number.
You mentioned that yourepresent how many companies?
Now, if they're only one you'reonly going to get what that one
has to offer, correct?
Speaker 3 (22:10):
Correct.
Yeah, and their incentives.
It's then the captive agentswith commission and the salary.
Yeah, they're going to push forthat.
What was the first part youwere doing?
Speaker 2 (22:21):
Anybody, any other?
I know you can't really namenames.
We have any questions for ifthey want to talk to an agent to
help, because I have, I coulddo it, but I don't want to.
I read enough contracts.
Speaker 1 (22:36):
Kevin, let me ask you if they lose their coverage
because they didn't do anythingwith this annual enrollment
period and January 1st comesalong, are they going to be
penalized because they aren'tenrolled in anything at that?
Speaker 3 (22:51):
time.
As long as they enroll in a newplan within 63 days of their
plan leaving, that will open upa window for them.
But meanwhile, if they don'trealize it until too late in
January and it's into February,their new plan won't start until
March.
So they're still at that 63-daywindow that starts March 1st.
(23:11):
So they won't have penalties.
I think that's what you'realluding to, right, the 1%
penalty per month.
They won't have penalties fortwo months without adequate
coverage.
That could be really scarywithout adequate coverage that
could be really scary.
The hospital part A the mostI've seen someone have to pay
was $90,000.
Your first day in the hospitalyou gotta whip out 1600.
(23:33):
And part B all the doctors andtests.
You gotta pay 20% of that.
I've had two clients in thesame year, same hospital.
One was in the hospital forthree months, one was four
months.
One paid $800,000.
One paid $1 million.
That's how much the bills were,not what they paid Advantage
clients.
Most of them have a built-insafety net.
(23:55):
It's called maximum out ofpocket.
Once you hit that it kicks in.
So you don't have to pay themillions.
But you still may have to payfive or six up to $9,000 of that
.
But no, they'll just be withoutcoverage until they can bring
coverage and they'll bemotivated.
But the TV, all of them.
I called and I put it in my zipcode to see what I would be
(24:17):
blessed with.
Right, what those companies?
Those are national commercials,many of them, and they've taken
a small county in Kansas thathas a certain thing on a plan
that no one else in the countryhas.
So unless you have that zipcode you don't get that and
they're listing all those thingson the TV.
The other thing too if you call, it's always a recorded call.
(24:37):
They'll say is this Dennis Day?
Yes, you just said yes, theydelete this question.
Is this Dennis Day?
Yes, you just said yes, theydelete this question.
And now they've got you sayingyes and they can sign you up on
the phone without a signature onwhatever plan they want.
Seniors should never be talkingto salespeople on the phone,
especially not Medicare.
Many scams.
Speaker 1 (24:59):
That's pretty scary.
So long, Kevin.
If people suddenly wake up onJanuary 1st and find out I'm not
covered, how do they get a holdof you?
Speaker 3 (25:09):
360-355-6560 or Medicare10 at gmailcom.
So I'm happy to talk to anybodyon the phone.
Judy said we don't chargeanything and if we can't get it
fixed before midnight onSaturday, well, I'll give you
instructions on what we can dofor January with your plan.
(25:30):
But I will stay up all nightlong If people call and say that
they're losing their plan.
Those are the ones I want totalk to, especially to make sure
they don't go a couple monthswith just basic traditional A
and B.
Speaker 1 (25:44):
Yeah, thank you for this fantastic information,
kevin.
This is really helpful and Idon't think a lot of people
really know this is happening.
Speaker 3 (25:53):
Yeah, but you think about it, judy, you're on
Medicare, don't you get a bunchof stuff in the mail?
Don't you get phone calls andlike it hits you, yeah, for you,
I'm terrible.
Speaker 2 (26:06):
I see it says UnitedHealthcare and they want
to have someone come to my houseand I don't want them to come
to my house, so I just don'tanswer.
Speaker 3 (26:13):
I'm a little different because I have the
capabilities of recording phonecalls.
The last one I ended up gettingNicole when it was her third
Medicare.
I said a chief caretaker chargea recorded call with someone's
and here's his agent number.
We'll access that recordingbecause he didn't tell me if I
picked humana's honor program.
(26:34):
Yeah, they're gonna give meback on my social security,
that's awesome, but there's nodrug plan built in because I'm
supposed to get my drugs throughva and he never told me that.
He never mentioned, mentionedit.
If people from out of state getcomplaints and people in state,
you only get so many in aMedicare Yanks, yanks your
license.
Speaker 1 (26:52):
You can't do it anymore.
Can you operate in other states, sell plants there, oregon,
washington, oregon that's ananonymous, they might call you,
but I'm not sure you have roomto help them.
Speaker 2 (27:04):
Are there people you could recommend in other states?
Speaker 3 (27:08):
Yeah, there was a group of eight of us that are
all over the place now thathelped Unite Healthcare I don't
remember what it was 15 yearsago or whatever it was come to
Cowlitz County and those aresolid men, good ethics and
morals.
They're just like me, never doanything illegal and so, yeah, I
(27:28):
have people in other states Ican refer to Good.
Speaker 1 (27:31):
Thank you Kevin.
Speaker 2 (27:34):
That is a lot of valuable information.
Speaker 3 (27:37):
Just send me an email , MedicareChev at gmailcom and
your phone number.
That gives me permission tocall you.
Speaker 1 (27:46):
Thank you again, Kevin.
This has been very helpful andwe'll probably see you again
next year.
Speaker 3 (27:53):
And to correct Judy, this is my third time on your
podcast, right, is that?
Speaker 2 (27:58):
right, yeah All right .
Thank you.
Speaker 1 (28:00):
Good night, you guys.
Speaker 3 (28:01):
You're both awesome.
Bye.
Speaker 1 (28:04):
See you later.
That's it for this episode ofGetting your Edge how to Right
Size your Home Life podcast.
We're here to help.
If you need to get a hold ofKevin, we can help you with that
.
If you need information aboutselling your home, buying a home
or just general information ondownsizing, we've got it all.
(28:25):
Thanks again.
See you later.
Bye-bye.
Welcome back everyone .
This is Dennis Day.
With Getting your Edge Out ofRight Signs, your home and life
podcast, We've got a veryinformative show about Medicare.
Before I get going, I want tointroduce our co-host, Judy
Gratton.
Speaker 2 (00:15):
Hi Dennis.
Speaker 1 (00:16):
Hi, jay.
Our guest is Kevin Anderson.
Has been working Medicare forthe past 12 years, enrolled over
800 people.
Kevin has a sets you apart froma regular Medicare agent, much
more informative and helpfulthan the 1-800 numbers, kevin,
(00:36):
that's for sure.
Why, kevin?
What's the difference betweenyou and other brokers?
Speaker 3 (00:42):
One of the key things this year instead of being an
adaptive agent for one company,we found it necessary to become
brokers.
I'm appointed with fivecompanies in your area.
I can write 38 plans.
I'm not a captive, so we havethe freedom to find the perfect
plan.
Most common thing I hear is Iwant the same plan you gave my
(01:06):
best friend and I said there'sabout a one in 25 chance it
happened.
But let me ask you somequestions.
We want the best plan for him,but it wasn't the same as his
friend.
Being a broker gives us thefreedom to find the best plan.
Make sure networks areappropriate for the individual,
and that's why I'm good at whatI do.
Speaker 2 (01:28):
Kevin has been our broker for two years, I think,
or is it three.
This year everything changed.
I had Kevin up before.
It's important for people tounderstand the changes this year
and how it could affectMentioned me, Kevin People who
want to change plan.
I want the.
When they saw what was, theydidn't want it.
That was me.
Speaker 3 (01:49):
No, you weren't alone .
I had a couple of those today.
Speaker 1 (01:53):
What are the key changes from 2024 to 2025 in
Medicare and how will theyimpact seniors?
Speaker 3 (02:03):
It is every advantage plan drug plan will choose to
exist December 31st why plansare being dissolved because of
changes in Medicare.
Many people won't be awareuntil January 1st that they've
reverted back to simple A and BMedicare without a supplement or
Advantage plan.
Several companies have leftthis.
(02:25):
Many counties in Washington,well-known companies leaving
permanently, starting in January.
Let's see if I can do it in anutshell without making two-hour
Medicare seminars.
Speaker 2 (02:38):
Okay.
Speaker 3 (02:39):
Because of companies' counties, the big void.
At least two companies havecome into Washington for the
first time.
Other states, not onlyWashington, but in every single
county they're the only Medicarecompanies in every county
Brings challenges toestablishing networks.
(03:00):
Here is big in Oregon, but thisis their first time in
Washington.
It's a scary thing.
Big company leaving inWashington.
69,000 people will wake upJanuary 1st without a plan if
they didn't do anything.
Those blooms and people can'tenroll in a plan.
It's unfortunate, but I'lltouch on more of this as we go.
Speaker 2 (03:21):
Why were there changes in Medicare happened and
what are the goals intended tobe achieved by these changes?
Speaker 3 (03:29):
Judy, that's a good question and gets to the heart
of the matter.
The big news is that the donuthole will cease to exist
starting in January.
Congress has been working onshrinking the donut hole to help
seniors.
Congress has been working onshrinking the donor role to help
seniors In 2022, presidentBiden's son in the inflation
(03:49):
reduction and eliminating therole Huge.
My wife and I both do Medicareand we've had people with drug
lists who paid $28,000 a year.
It's a record in the low twentythousand dollars.
Once you and the plan paid fivethousand, not counting premium,
you under the donut hole, thetwenty five percent on a typical
(04:14):
tier three, the free, thecopayment might be 45 bucks.
All of a sudden they're fourand five hundred in the donut
hole hoping to get out next yearonce they've reached $2,000 in
deductibles or co-pays the restof the year.
I applaud President Biden.
Another change is payment planfor prescriptions Starting in
(04:39):
January.
Folks that spend $24,000 a yearin drugs, that's $10,000 a month
.
After January.
The drugs will be free afterthat.
Right, not very many of us canspend $10,000 in one month.
Right, we're on fixed budgets.
Seniors have downsized.
They've moved into.
You guys know all about thatmore than I do.
(05:00):
They're on a set budget thatdoesn't grow unless you count
little raises in their socialsecurity.
They're on a set budget.
It doesn't grow unless youcount little raises in their
social security.
They're on a fixed budget.
How do you pay the $2,000?
Medicare says starting nextyear.
What we'll do is we know youwon't have drug payments after
this.
We'll divide it into 12 months.
They won't discount it, soinsert a $2,000 in January.
(05:22):
I don't know what $2,000divided by 12 is.
Judy's super good at math whenshe has a calculator in her hand
.
When she has a calculator inher hand.
Speaker 2 (05:30):
Ah, okay, yes, I do, right here.
It's called my phone.
I'll look.
Speaker 3 (05:34):
It's going to be like $105 in January and each month,
I'm guessing, but that's betterthan $2,000.
And that's brand new and that'sfrom the inflation reduction
net.
So those are good things.
Now, one of the results of thatis that drugs that $166.66.
Speaker 2 (05:55):
There you go.
Speaker 3 (05:56):
Well, it's $8.44.
The whole thing is gearedtowards helping seniors lower
the cost of their medication,and so that's a great thing.
Would you like to know how thepremiums and deducted and
co-pays will change?
Speaker 1 (06:12):
Absolutely.
I've been waiting all day forthis.
Speaker 3 (06:15):
Medicare allows drug plans standalone drug plans or
embedded in advantage plans.
They allow a $590 deductible.
That's the max.
Now companies can go with less,but most of the drug plans are
$500.
If we're talking in the $37 to$48 range a month or premium for
(06:40):
a drug plan, they're going tohave to pay the whole $590.
Now, many companies that haveAdvantage plans with the drug
plan, they're going to have topay the whole $590.
Now, many companies that haveAdvantage plans with the drug
plan built in, they said 90% ofprescriptions are generic.
Tiers 1 and 2, they're fine.
Tiers.
Tiers 1 and 2 are generic.
We won't apply a deductible tothat.
We'll just apply a deductiblefor tiers 3 and up.
(07:01):
That's a huge help, right.
And they might say a deductiblefor two years.
Three and up.
That's a huge help, right.
And they might say, dependingon the plan and depending on the
company, instead of $590, we'reonly going to charge $150
deductible.
So that's another good thing.
It's making money on lemonade,because it isn't such a great
thing that people have to paythe deductible where they never
(07:21):
had to do that before.
If you want a standalone drugplan without a deductible, the
cheapest one that I know is $83a month and I haven't enrolled a
single person in it.
Now many people have beenmapped over to that by their
companies because of the planthat they had that went away.
The company is going toautomatically put them in
another drug plan.
(07:42):
But the reason I don't like it$83 a month, remember.
Premiums don't count towardsyour $2,000.
So you get rid of the $590deductible.
You start just paying co-payson your medications but you
don't get credit for that $83 ormore a month.
You don't get a thousand dollarcredit towards a $2,000 max.
It doesn't make any sense in myway of thinking.
(08:05):
Now, in the past it wasimportant because you paid $100
a month or $110 a month for apremium for a drug plan, but
then you had reasonable co-pays.
Now my own drug plan I'm not onan Advantage plan.
There aren't Advantage plans.
In the county that is now mypermanent residence Most overall
(08:25):
as a general term, there's noadvantage plans.
So I have a standalone drugplan.
Mine, if I kept that one, wentup tenfold for January and
included a $590 deductible.
It went from $3.70 a month.
Very few people know about thatdrug plan but I have a great
agent.
(08:45):
My wife put me on that plan andinstead of $3.70 a month
premium they want you to pay $37a month next year.
That's tenfold Now.
The other big change is manyplans I won't say a majority of
them, but pretty close to atleast half the plans now will
have a medical deductible.
(09:07):
That's brand new news to me.
I haven't seen that before inthe state of Washington.
So before your zero copay foryour physician visit, you've got
to meet a $175 deductible orwhatever the deductible is.
Unfortunately, the biggestcompany doesn't do that.
They don't have a medicaldeductible.
So those are some of thechanges that we're going to see.
Speaker 2 (09:30):
That could be really expensive if you're not careful.
Speaker 3 (09:34):
It is and we'll get it to the end on what people can
do if they've made a mistake orthey don't know how to.
For instance, today isWednesday, medicare opener
annual enrollment, and Saturdayat midnight.
We're down to the last threedays Thursday, friday, saturday
and in years past we've hadappointments showing up at
(09:57):
houses on December 7th at 11 pm.
Back then Jen had to do thewhole list.
The case is one at a time.
I forgot the question, just toremind you.
Jen had to do the whole list.
The question is one at a time.
I forgot the question.
I have just to remind you Ihave attention deficit disorder,
so I go down rabbit trails andsometimes I don't make it back.
Speaker 2 (10:14):
I think you have earned that.
It sounds like over the lastfew weeks trying to help people
understand what the best choiceis for them, and I really Kevin
sat down with us with threedifferent plans and explained
the three that he saw for ourparticular needs, and then we
made a decision based on that,but it took a lot of work.
(10:36):
One of the things that I knowhas changed dramatically is
dental, which I'm very much astickler about dental, and so
Kevin had to go hunting to findsomething that worked for us
with dental.
Speaker 3 (10:53):
There's another challenge that doesn't affect
very many people in youraudience, but people that have
Medicare and Medicaid.
That whole arena and that'soutside the scope of this
webinar that little arena ischanging dramatically.
Companies, that one, onecompany has eight dual plans
where before they just had two,an hmo and a ppo, now they have
(11:14):
eight.
Now we have to determineeligibility or and, and then
there's an integrated issuethat's going to come up in the
next few years, where thecompany that gives the dual
plans has to be integrated withMedicaid and a contract with
Medicaid so that they only getbilled once.
Doctors don't have to spend,send part of the bill to one
(11:35):
place and then the other part toMedicaid, so there's a same one
.
Thank you, judy, for thecompliment.
I appreciate it.
Speaker 2 (11:42):
Well, I'm very serious about that and that's
why I wanted to have you back on, so hopefully people hear this
Now.
You mentioned something brieflyabout if they don't have an
open enrollment period, butisn't there a period in the
first part of the year wherethey can still make a change?
Speaker 3 (12:01):
Yes, it's fair.
Just a few years ago it'scalled open enrollment period.
People call the one we're inright now open, but it's annual
enrollment period that goesthrough December 7th.
A-e-p, o and B you're right,judy starts January 1st and goes
to the end of March.
It's only for people withAdvantage plans and I'm glad
(12:23):
Medicare started this a fewyears back.
If you have an Advantage planthat you don't like, or you
signed on to one because youwatched the TV commercial or
whatever and you signed out it'snot what you were hoping for.
In January and February andMarch you can change to any
other Advantage plan guaranteeissue, no waiting periods, no
(12:45):
pre-existing conditions and youcan get the plan that's best for
you.
Now that's really important inthe companies that stayed.
The companies that stayed havesent back.
In the first week in Octoberthey sent annual notification of
change letters to everyone andit said here's your plan for
2024.
(13:06):
Here's the plan we're puttingyou in for 2025.
If we're talking aboutUnitedHealthcare, that's 20 new
Advantage plans, 20 that theyhave for this year.
And so a computer decidedyou're on this certain PPO,
we're going to put you on thisother PPO, yeah, and your
premium is going to jump to $46.
(13:26):
It doesn't come with any dentalanymore or it might include
just cleaning, something likethat and people go, oh okay.
And then I've been called somany times just even today again
and I called and activated mynew car and I didn't have to
come and see you.
Should I cancel my appointment?
No, you shouldn't.
Let's have the appointment andlet's see if that's the best
(13:48):
plan for you, and in a veryshort order we find out it's not
.
But that's perfect.
For those whose companiesstayed Not like regions that
left you have nothing right.
But if that company stayed,whether it's Humana or
UnitedHealthcare I won't mentiona couple of the others.
It's just better not to mentiona couple others.
I don't want to disparageanybody, but for those that
(14:11):
stayed, they mapped over theirclient base to a new plan.
Some companies called it frostblocked them over, so they won't
be without coverage and duringOEB we can change you.
So that brings a lot of hope.
Speaker 2 (14:26):
One point I want to make because I don't think
people understand this but yourservices don't cost them
anything.
Speaker 3 (14:33):
No, and I had 10 appointments today and twice I
was asked this question.
Judy just made a statementabout how much do we owe you?
I just spent two hours withthis.
Do I have to pay you?
No, and it doesn't matter if Ienrolled you a premium of zero,
a plan that costs nothing, or ifI enrolled you in an F plan
(14:55):
supplement that costs $330.
It doesn't matter, I get paidthe same.
The companies pay us and thecompanies have that money
because Medicare pays them toadminister the plan.
So now it's free and everyoneshould utilize an agent or a
broker.
It's very helpful and theydon't make more money
recommending certain plans.
Speaker 2 (15:17):
So, going back to why did all these changes like loss
of dental and different thingswhy?
Speaker 3 (15:25):
Okay, simply, your drugs this year are free after
you pay $8,000.
Next year they're free after$2,000.
Companies have a $6,000 gap.
Right Now everyone makes itinto the normal, but lots more
people are going to make the$2,000.
So how do they build a plan?
(15:46):
They have a certain amount ofmoney for Medicare that they
have to give back 85% inbenefits.
They're allowed 15% forexpenses and employees and
profit ROI.
So they have to make up $6,000.
Now some companies juststripped bare bones the medical
Instead of $25 for a specialist,maybe it's $65, for example,
(16:09):
right Instead of $1,000 fordental.
One company has $250.
And not only is it $250 fordental, it's your total for
dental and vision.
So they stripped down to makeup that $6,000 hole.
Now I don't mean to just talkabout one plan, but the only
company that illustrates whatI'm trying to say the best is
(16:32):
UnitedHealthcare, with 20 newplans.
So they built a plan withcertain kinds of frosting on the
cake.
The cake is the same size.
Medicare is Medicare.
Here's the cake.
Maybe I want less cake and morefrosting.
Maybe I just want a bite ofcake in the middle and lots of
frosting.
Being the auxiliary benefits oralter therapies, like some
(16:53):
people are into naturopath andthe acupuncture.
Some people really enjoychiropractor.
Those are alternative therapies.
There's only three plans inyour county that includes those
things, but then they might nothave over-the-counter, they
might not have glasses.
Some don't even have dental atall or they might only do
cleanings.
(17:14):
And offer a dental say $54 amonth, we'll give you $1,500.
Offer a dental, say $54 a month, we'll give you $1,500.
So pay $600 a year, we'll giveyou $1,500.
Dental which he's alluding tois one plan has $2,500 of dental
and it also has $50 ofover-the-counter.
That's fantastic, but not allplans have that.
(17:36):
And some people have dentures.
People our age, a lot of us,don't have our own teeth.
People with dentures don't needdental coverage.
They get a realignment of theirdentures every five years,
whatever it is.
So why let the plant havedental?
Let me use that money, that$6,000 hole.
Let's use that money forsomething else.
Speaker 2 (17:59):
And that's what you did with us.
You asked us, we gave you alist of our doctors, we did all
the different things and thenyou were able to show us the
plans that best suited our needs.
And I just it's.
I think it's really importantfor people to consider speaking
to you or someone like you to dothis, to make sure that.
Because you said now, werepeople notified if regents
(18:22):
leaves, did they notify peoplethey were going to be gone or
they just don't have anythingcome january 1st surprise?
Speaker 3 (18:29):
people without agents regents oh, regents, I'm sorry
I took my hair is up okay no,they received an annual
notification of change.
That's required.
The problem is most of themthat I've seen are like little
pamphlets made out of browntissue paper.
They look like a refrigeratorwarranty or something that comes
(18:53):
in the box.
People get that and go I don'twant to read all that and they
throw it out.
So they're unaware that thechange is coming, unless a
friend has told them, and I'vehad a lot of people go.
My friend says I'm losing myplan.
Yeah, you got a letter about it.
No, I never got a letter.
Yeah, you did you just didn'tread it.
Speaker 2 (19:09):
I think Jim is the one who read about our plan
changing, and that's when wepicked up the phone.
Poor Kevin.
Speaker 3 (19:44):
Sounds like some of these's the College of
Integration Reduction Act.
There's a 1.9% max that's tiedinto that.
It's one of the things I didn'tlike about it, so I won't name
a company.
There was one company that did$300 million a quarter, I think
it was, and they were operatingon less than 1% profit, and when
(20:04):
the new contracts came out thatthey signed, they could see the
writing on the wall that theybarely survived profitability.
Many companies lost hundreds ofthousands a quarter this year.
They're going to lose theirnext year.
So rather than do that?
Speaker 1 (20:18):
they just what steps.
If somebody's unclear wherethey stand right now, what would
you suggest they do?
Speaker 3 (20:28):
There are a few people less than 1% that are
really good at research andreally good with computers.
A big majority of people ourage Medicare age.
They're a different generation.
They like their flip phone.
They don't know aboutsmartphones.
They don't know about computersvery well.
They can do Facebook usually,but sending a picture and a text
(20:48):
is hard.
But if someone is good atstudying, I recommend
Medicaregov.
Now Medicaregov is greatlyflawed.
There are several plans that weare appointed to do that people
have to qualify for, thataren't even listed in there, and
then many of the benefits areerroneously represented.
Medicaregov but it'll get yourfeet wet and so I suggest to
(21:10):
people to do an hour worth ofstudy.
Start with Medicaregov and plugin your zip code, plug in your
doctors and then play around inthere, see which providers cover
your doctors and then also yourprescriptions.
You should put your formularyin there, see which providers
cover your doctors and then alsoyour prescriptions.
You should put your formularyin there and then talk to a
broker or a Medicare agent,enrollment agent and then you'll
(21:32):
have some knowledge.
Then your questions will bewhat's the difference between
HMO and PPO?
Before you maybe didn't evenknow they existed.
Your questions will be smarter.
Speaker 2 (21:42):
Go ahead.
No, go ahead, you finish,because my question is different
.
Speaker 1 (21:48):
Oh, I'm done.
Speaker 2 (21:50):
Are there people they should avoid?
They could call you.
I hear a lot of advertisementon the radio and television and
whatnot for number.
You mentioned that yourepresent how many companies?
Now, if they're only one you'reonly going to get what that one
has to offer, correct?
Speaker 3 (22:10):
Correct.
Yeah, and their incentives.
It's then the captive agentswith commission and the salary.
Yeah, they're going to push forthat.
What was the first part youwere doing?
Speaker 2 (22:21):
Anybody, any other?
I know you can't really namenames.
We have any questions for ifthey want to talk to an agent to
help, because I have, I coulddo it, but I don't want to.
I read enough contracts.
Speaker 1 (22:36):
Kevin, let me ask you if they lose their coverage
because they didn't do anythingwith this annual enrollment
period and January 1st comesalong, are they going to be
penalized because they aren'tenrolled in anything at that?
Speaker 3 (22:51):
time.
As long as they enroll in a newplan within 63 days of their
plan leaving, that will open upa window for them.
But meanwhile, if they don'trealize it until too late in
January and it's into February,their new plan won't start until
March.
So they're still at that 63-daywindow that starts March 1st.
(23:11):
So they won't have penalties.
I think that's what you'realluding to, right, the 1%
penalty per month.
They won't have penalties fortwo months without adequate
coverage.
That could be really scarywithout adequate coverage that
could be really scary.
The hospital part A the mostI've seen someone have to pay
was $90,000.
Your first day in the hospitalyou gotta whip out 1600.
(23:33):
And part B all the doctors andtests.
You gotta pay 20% of that.
I've had two clients in thesame year, same hospital.
One was in the hospital forthree months, one was four
months.
One paid $800,000.
One paid $1 million.
That's how much the bills were,not what they paid Advantage
clients.
Most of them have a built-insafety net.
(23:55):
It's called maximum out ofpocket.
Once you hit that it kicks in.
So you don't have to pay themillions.
But you still may have to payfive or six up to $9,000 of that
.
But no, they'll just be withoutcoverage until they can bring
coverage and they'll bemotivated.
But the TV, all of them.
I called and I put it in my zipcode to see what I would be
(24:17):
blessed with.
Right, what those companies?
Those are national commercials,many of them, and they've taken
a small county in Kansas thathas a certain thing on a plan
that no one else in the countryhas.
So unless you have that zipcode you don't get that and
they're listing all those thingson the TV.
The other thing too if you call, it's always a recorded call.
(24:37):
They'll say is this Dennis Day?
Yes, you just said yes, theydelete this question.
Is this Dennis Day?
Yes, you just said yes, theydelete this question.
And now they've got you sayingyes and they can sign you up on
the phone without a signature onwhatever plan they want.
Seniors should never be talkingto salespeople on the phone,
especially not Medicare.
Many scams.
Speaker 1 (24:59):
That's pretty scary.
So long, Kevin.
If people suddenly wake up onJanuary 1st and find out I'm not
covered, how do they get a holdof you?
Speaker 3 (25:09):
360-355-6560 or Medicare10 at gmailcom.
So I'm happy to talk to anybodyon the phone.
Judy said we don't chargeanything and if we can't get it
fixed before midnight onSaturday, well, I'll give you
instructions on what we can dofor January with your plan.
(25:30):
But I will stay up all nightlong If people call and say that
they're losing their plan.
Those are the ones I want totalk to, especially to make sure
they don't go a couple monthswith just basic traditional A
and B.
Speaker 1 (25:44):
Yeah, thank you for this fantastic information,
kevin.
This is really helpful and Idon't think a lot of people
really know this is happening.
Speaker 3 (25:53):
Yeah, but you think about it, judy, you're on
Medicare, don't you get a bunchof stuff in the mail?
Don't you get phone calls andlike it hits you, yeah, for you,
I'm terrible.
Speaker 2 (26:06):
I see it says UnitedHealthcare and they want
to have someone come to my houseand I don't want them to come
to my house, so I just don'tanswer.
Speaker 3 (26:13):
I'm a little different because I have the
capabilities of recording phonecalls.
The last one I ended up gettingNicole when it was her third
Medicare.
I said a chief caretaker chargea recorded call with someone's
and here's his agent number.
We'll access that recordingbecause he didn't tell me if I
picked humana's honor program.
(26:34):
Yeah, they're gonna give meback on my social security,
that's awesome, but there's nodrug plan built in because I'm
supposed to get my drugs throughva and he never told me that.
He never mentioned, mentionedit.
If people from out of state getcomplaints and people in state,
you only get so many in aMedicare Yanks, yanks your
license.
Speaker 1 (26:52):
You can't do it anymore.
Can you operate in other states, sell plants there, oregon,
washington, oregon that's ananonymous, they might call you,
but I'm not sure you have roomto help them.
Speaker 2 (27:04):
Are there people you could recommend in other states?
Speaker 3 (27:08):
Yeah, there was a group of eight of us that are
all over the place now thathelped Unite Healthcare I don't
remember what it was 15 yearsago or whatever it was come to
Cowlitz County and those aresolid men, good ethics and
morals.
They're just like me, never doanything illegal and so, yeah, I
(27:28):
have people in other states Ican refer to Good.
Speaker 1 (27:31):
Thank you Kevin.
Speaker 2 (27:34):
That is a lot of valuable information.
Speaker 3 (27:37):
Just send me an email , MedicareChev at gmailcom and
your phone number.
That gives me permission tocall you.
Speaker 1 (27:46):
Thank you again, Kevin.
This has been very helpful andwe'll probably see you again
next year.
Speaker 3 (27:53):
And to correct Judy, this is my third time on your
podcast, right, is that?
Speaker 2 (27:58):
right, yeah All right .
Thank you.
Speaker 1 (28:00):
Good night, you guys.
Speaker 3 (28:01):
You're both awesome.
Bye.
Speaker 1 (28:04):
See you later.
That's it for this episode ofGetting your Edge how to Right
Size your Home Life podcast.
We're here to help.
If you need to get a hold ofKevin, we can help you with that
.
If you need information aboutselling your home, buying a home
or just general information ondownsizing, we've got it all.
(28:25):
Thanks again.
See you later.
Bye-bye.
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