July 6, 2025 • 24 mins
Navigating Medicare with Michelle Schafer: Insight and Tips
In this episode of Peaceful Life Radio, hosts David and Don Drew sit down with Michelle Schafer, a licensed independent Medicare agent with extensive experience since 1995. The discussion revolves around the intricacies of Medicare, including the differences between Original Medicare and Medicare Advantage plans. They unpack the enrollment process, potential penalties, and the importance of timing. Michelle offers valuable advice on the benefits of working with Medicare agents, and delves into disability provisions and additional services Medicare covers, such as hospice care. Together, they emphasize the importance of expert guidance to navigate Medicare's complexities effectively.
00:00 Introduction to Medicare Choices
00:32 Meet Our Guest: Michelle Schaefer
01:36 Understanding Medicare Basics
02:30 Medicare Enrollment and Penalties
03:49 Medicare Parts Explained
05:55 Medicare Advantage vs. Original Medicare
13:31 Costs and Penalties in Medicare
15:32 Medicare for Disabilities and Special Cases
17:20 The Role of Medicare Agents
20:43 Steps to Enroll in Medicare
22:57 Conclusion and Final Thoughts
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Michelle Schaefer (00:00):
When you go on Medicare, it's kinda like the
(00:02):
first time you walked into acell phone store and said, I'd
like a cell phone.
They said, okay, sir, do youwant an apple or do you want an
Android?
So there's a big fork in theroad.
The Advantage plan companies arevery interested in keeping you
healthy.
So they have what I call a lotof shiny stuff, and they have
dental, vision, chiropracticbeds, just hearing aids, gym
memberships, all that stuff thatyou see on TV and the, the stuff
(00:23):
you get in the mail.
And on the original Medicareside, it costs more a month.
And there's no shiny stuff, butyou go to whatever doctor you
want.
David Lowry (00:32):
That was Michelle Schaefer, our guest today on
Peaceful Life Radio.
She's a licensed independentMedicare agent.
And with me today is Don Drew.
How are you, Don?
Don Drew (00:41):
I'm doing great, David, how was your trip to
Florida?
David Lowry (00:44):
Florida was great.
I recommend that everybody go asoften as possible.
Hey, let's talk about Medicaretoday.
And that's a big topic we allneed to know about.
Why don't you introduce ourguest, Michelle?
Don Drew (00:57):
You bet, David.
Our guest today is MichelleSchafer, a licensed independent
Medicare agent and owner of theSchafer Agency.
She has been a licensed agentsince 1995 and is dedicated to
helping seniors navigate thecomplexities of Medicare.
I.
Based in Edmond, Oklahoma, shebrings a wealth of knowledge and
a compassionate approach to eachclient's unique situation.
(01:17):
With her goal being to make theenrollment process as smooth as
possible.
Michelle is passionate aboutgiving back to others through
service in Rotary International,and has been the director of the
Downtown Edmond Arts Festivalsince 2021.
Michelle Schafer, welcome toPeaceful Life Radio.
Michelle Schaefer (01:33):
Thanks for having me.
Glad to be here.
Don Drew (01:36):
Michelle, I think most people understand that Medicare
is our country's healthinsurance program for people age
65 or older.
There are some other exceptions.
Hopefully we'll get aroundtalking about some of that, but
all of us will eventually needto understand Medicare.
So let's just start there.
What exactly is Medicare?
Michelle Schaefer (01:53):
Medicare is the option for your health
insurance when you're over 65,if you are not currently on a
group plan or other kind ofcoverage that covers you.
Don Drew (02:03):
So after 65, you don't have to go on it at 65 if you
are covered, correct?
Michelle Schaefer (02:09):
Right.
So if you have what's called acredible policy, which most
group plans are, then thatprotects you from having a late
enrollment penalty or not beingable to enroll for a while
because you didn't havecoverage.
So as long as you're on a groupplan, if you don't wanna go on
Medicare, you do not have to.
David Lowry (02:30):
Let's talk about that penalty right there,
because that's a gotcha that youneed to know about.
Michelle Schaefer (02:34):
There are things that are not credible
coverage such as COBRA.
So if a company would let somefolks go who are over 65 and
say, Hey, we're gonna give youthree months of COBRA, and then
they come off to three months ofCOBRA and find out that they
have exceeded their timeline forgetting on a Medicare plan,
that's a problem.
So the easiest way to do it isto go straight from the day the
(02:57):
group plan ends.
Start.
Medicare always starts on thefirst of a future month.
So if the group plan ends on theend of the month, you start
Medicare on the first of nextmonth, and then there's no gaps,
so then there's no penalty.
David Lowry (03:08):
What happens when you're penalized?
Michelle Schaefer (03:10):
It could be that you're not allowed to
enroll until after the first ofthe year.
So you could have no coverage.
And then there's also afinancial penalty that is
permanent and on there foreverand ever.
David Lowry (03:22):
So you really wanna get enrolled when you can.
Timing is critical.
Don Drew (03:28):
I do wanna mention, Michelle is not an expert in
social security per se, butthere is one link to social
security that's pretty importantfor people to understand.
What would that be, Michelle?
Michelle Schaefer (03:37):
If you are getting Social security, your
Medicare premium willautomatically be deducted from
Social Security before it evenhits your bank account.
If you're not on social securitythen you just have to set up a
monthly bank draft with them.
David Lowry (03:49):
Now, as I recall, there was Part A and Part B of
my Medicare, and Part A happenedalmost automatically for me.
I just went online or somethinglike that.
It didn't cost anything.
I just checked the box andsuddenly I got something in the
mail and I have Part A.
But Part B is a different story.
Right?
Michelle Schaefer (04:09):
Medicare is divided into two parts.
So if you think of'A make a roofwith your hands,'A is for under
a roof.
'A covers you in a hospital orin a skilled nursing facility.
And if you have worked 40quarters, 10 years at a certain
income level, your'A costs zero.
So sometimes people when theyturn 65, even if they're still
(04:30):
on a group plan, we'll go aheadand enroll in a, because it
doesn't cost anything and itmight bring their group.
Out of pocket for hospitalcoverage down to$1,600.
'B is everything else.
Your doctor's appointments, yourlab work, your durable medical
equipment.
There is a premium for B.
So you do not need'B and a groupplan at the same time.
(04:52):
It's either or because it's justduplicating itself.
Don Drew (04:56):
And then the other thing I think we hear a lot
about is Part D, right?
Delta.
Michelle Schaefer (05:00):
D for drug.
Don Drew (05:01):
Okay.
Michelle Schaefer (05:02):
Drugs, they give D for drugs.
Don Drew (05:03):
So that's all your prescription, right?
Michelle Schaefer (05:05):
Because Medicare itself, A or B, does
not cover any drug plans, exceptif you go into a doctor's office
for a drug, say an infusionthat's covered under Part B.
But anything you go to thepharmacy and you administer
yourself at home a drug plan.
And the interesting thing withthe drug plan is sometimes
people say, oh, I don't take anydrugs.
(05:25):
Why should I buy a drug plan?
Again, there's a penalty forevery month.
You should have had a drug planand you didn't.
There is a permanent lifetimepenalty and that penalty
increases every month you don'thave a drug plan than you should
have.
David Lowry (05:40):
I'm glad we're talking to you because it can be
very confusing, but fortunatelythere are people like you,
Michelle, out there.
What are our choices when wesay, okay, I gotta have this and
I know I've gotta have Part B?
Yeah.
How you start all this?
Michelle Schaefer (05:55):
When you go on Medicare is kinda like the
first time you walked into acell phone store and said, I'd
like a cell phone.
They said, Okay sir.
Do you want an apple or do youwant an Android?
So there's a big fork in theroad.
You have to make this decisionfairly early about which way
you're going.
And just like Apple and Android,there's no wrong decision.
The best plan is the one thatworks for you.
I will always present both sidesof it.
(06:17):
They both have advantages.
They both have disadvantages.
You pick the best plan thatworks for you.
So there's a big decision to bemade.
One is original Medicare, so youhave your'A and your'B.
But there's a lot of thingsthose plans don't pay for.
So what most people do is get asupplement.
So a supplement works hand inglove with Medicare and will pay
what Medicare doesn't, exceptfor a very tiny deductible of
(06:39):
$257 a calendar a year.
And then you wanna add a drugplan.
because none of those cover drugplans.
So that's.
That's one side of the decision.
The other side is an advantageplan.
So what an advantage plan doesis Medicare pushes your files
across the table to an insurancecompany and says, here, you take
care of him.
We're gonna give you some moneyevery month, and then we're
(06:59):
done.
The Advantage plan companies arevery interested in keeping you
healthy.
So they have what I call a lotof shiny stuff.
So they roll in the drug plan.
They have dental, vision,chiropractic, podiatrist,
hearing aids, gym memberships,all that stuff that you see on
tv and the stuff you get in themail.
And the premiums on those can bezero.
They're very, very low premium.
(07:21):
However, you have to use thedoctors in the network.
When you're on the supplementside, any doctor who takes
Medicare will take that.
But on the advantage side, youhave to be in a network and
there could be some largeout-of-pocket costs if you do
some things that the plandoesn't fully cover.
Whereas a supplement you're keptout at for this year,$257.
David Lowry (07:42):
People are going to wonder what the advantages of
each of them are.
I'm certainly not verbose enoughto tell you what all those are,
but I do know that when I waslooking at one plan, it reminded
me of when I was at work, I hadthe healthcare plan offered by
my job, and it looked verysimilar to what I'd been having
all these years, and that wasthe Medicare Advantage plan.
(08:03):
And so it was attractive to mebecause I was used to going to a
certain place, certain doctorsand being covered.
Plus it had the gym membershipand that was pretty sexy too.
Then on the other side, itseemed to me like I had more
flexibility of doctor choices ifI went with the standard
Medicare.
I could choose who I wanted aslong as they would accept
(08:25):
Medicare.
Are there other advantages anddisadvantages that I'm missing
here?
Michelle Schaefer (08:29):
No matter what, you're gonna pay your Part
B premium.
Yeah.
No matter which path you godown, you're paying your Part B
premium, so that levels thatplaying field on your Part B
side.
One of the disadvantages is withthe supplement, you're paying a
premium every month, and itcould be anywhere from a hundred
to 150, depending on your ageand your zip code.
(08:50):
If you smoke and if you haveanother adult human living with
you in the household, there'sjust different discounts you can
get.
There's no shiny stuff and youmentioned the shiny stuff, the
gym membership and all that.
On the original Medicare side,it costs more a month and
there's no shiny stuff, but yougo to whatever doctor you want.
On the advantage side, premiumis really, really low.
(09:11):
Includes the drug plan, the gymmemberships, and the fitness,
and the over the countervitamins.
They wanna keep you healthy, sothe premium's really low.
However, you have to be sure youuse the doctors in the network
and.
If you have chemo drugs or haveto go on dialysis, or you have
an extended nursing home stay,you can have up to a$5,000 per
(09:32):
calendar year out of pocketexpense if something happens.
David Lowry (09:35):
On the Medicare Advantage plan, are there
certain things that they'reallowed to say, We don't cover
that?
Michelle Schaefer (09:41):
An advantage plan has to cover all the stuff
that Medicare itself covers.
Oh, okay.
I can't skimp on that, but it'svery flexible what they can add
in.
And that changes every year.
Some years there was anadvantage plans that gave you
cash back on your Part B.
There was some that gave you bigover the counter allowances.
(10:01):
Those flex every year, dependingon the market as an agent, we
don't find that out until Augustand September.
We cannot talk about it untilthe 1st of October, and then we
have your annual enrollment inthe fall when they make all that
Medicare noise, that's the timewhen there are some plans you
can hop from plan to plan ifthere's a better plan.
Don Drew (10:21):
Michelle, we've mentioned that Medicare doesn't
cover some things.
I'm sure that list is long andthey can probably go online and
see what that is, but what aresome of the things that they
don't cover that generally catchpeople off guard or surprise
them?
Michelle Schaefer (10:36):
So of course there's no dental in medicare.
Medicare will cover anythingthat is medically necessary.
So if your doctor says, Hey, weneed you to go to the labs and
check your cholesterol and checkyour vitamin D three and check
your blood sugar, Medicare'shappy to pay for that.
But if you go in and just say,let's run all the tests, let's
just go to the lab and run'emall.
(10:56):
Medicare's not gonna pay forthat because it's not medically
necessary.
Where people get caughtsometimes is you need cataract
surgery.
That's a medical procedure.
Medicare's happy to pay forbasic cataract lenses, but but
if you want the bionicc lenses,you're gonna have to pay for
that.
And your doctor's billingsoffice are really good about
telling you here's what's gonnabe covered and here's what
(11:18):
isn't.
Don Drew (11:19):
I'm glad you brought that up because I've been on
Medicare two years I think, andI got caught right away.
I had a situation in which, inmy annual physical, I was used
to have meeting the doctor,getting my blood work done, and
then I lost my chance to talk tothe doctors.
So I called him up and I said,can you go ahead and schedule
him the test ahead of time so Icould talk to the doctor during
the visit?
I ended up paying severalhundred.
(11:40):
Of dollars for that because itwasn't requested by the doctor.
Michelle Schaefer (11:44):
Your doctor's billing office will be able to
tell you that because that'swhat they do.
But you said it might be a longlist.
It's really not.
David Lowry (11:50):
The main thing is don't count on that being paid
for until you talk to yourdoctor.
Wow! There is so many nuances toMedicare and I guess a person
could shop around and make thishappen.
But it's like doing your owntaxes, isn't it?
You can do it if you want.
But let's talk about why anagent is a useful experience for
(12:13):
people who are looking atMedicare and trying to stay on
top of their needs.
Michelle Schaefer (12:17):
For one, our training.
Every year in August, we have tostudy countless hours and take a
big test called an AHIP test tobe certified as a Medicare
agent.
And then we spend countlesshours with each of our carriers
learning about their plans.
And there's online training andthere's in-person training and
there's conferences that we goto.
(12:38):
So a lot of training.
And you're right about thenuances.
It's like every rule has anexception, but every exception
has an exception.
And if you're not aware of allthe little rules you could get
caught.
So yes, a person could go onlineand spend hours and slog through
it themselves and figure it outand hope they did it right.
At the advantage of an agent isnumber one, our training.
(13:00):
Number two, it costs you nothingto talk to an agent.
We're gonna write probably aboutthe same policy as you would do
it online, but the big thing iswe're gonna keep an eye out for
you.
So in the fall, when I find outthat those policies have
changed, I can call my peopleand say, Hey, I'm looking down
the road.
You are gonna want a differentpolicy come January 1st, so
let's fix that.
(13:21):
Whereas if you just call an 800number, you go online and do it.
Nobody's watching out for you.
Whereas an agent.
Cost you nothing to work withand we're gonna take care of
you.
Don Drew (13:30):
Can we talk about how much all of this is gonna cost?
There's a general Medicare costfor Part B, I believe.
But this was another surprise Igot was something called IRMA.
What is Irma all about?
Michelle Schaefer (13:40):
So in 2025, the Medicare premium for Part B
is$185, and that is set everyyear by the Center for Medicare
is what we call CMS, the Centerfor Medicare Services.
So that is set, and we'll findout in the fall what that is.
Every year the deductible is setby them and it goes up.
(14:01):
Every year.
Year.
I just pretty much guarantee youthat.
So your base Medicare Part Bpremium is 185.
Then there's a thing called Irmawas the income reduction monthly
Medicare amount.
And that just says the more youmake, if you are blessed to be a
higher income earner, you'regonna pay more for your Medicare
premium.
It could be about$75 more.
(14:21):
It could be$185 more.
It could be$400 a month more.
It just depends.
The asterisk there is if you'vehad a life change, say you've
retired, you were a high incomeearner, and they look back two
years, by the way.
So if you go on Medicare in 25,you're gonna look at your 2023
tax return line two A, which isyour federal tax exempt
(14:42):
interest, and line 11, which isyour adjusted gross income.
That's the only two things theylook at, and so if you say,
well, I did make this much, butnow I'm retired and I make zero,
I can help you turn in arebuttal form and say, Hey,
there's been a life change.
My income is no longer this.
Don't charge me the penalty.
David Lowry (15:03):
If you file together, is it the adjusted
gross income of both of you?
Michelle Schaefer (15:07):
Right.
Most people who are marriedfollow jointly, and it goes off
of that.
David Lowry (15:11):
Gotcha.
So when you fully retire andhang it all up, that could reset
things for you a bit dependingon how much you're bringing in
at that point.
That makes sense.
Michelle Schaefer (15:20):
They evaluate that every year, which is why
you start Medicare at SocialSecurity's website and not
Medicare's website because ofthe income factor.
Don Drew (15:30):
Michelle, if we could, I'd like to talk about some of
the other ways Medicare canhelp, such as in cases of
disability and so forth.
I know there's a lot of othersituations in which Medicare
kicks in that isn't based solelyon turning 65 and so forth.
What are some of thosepossibilities for our listeners
that might have use of Medicarebut don't fit that model?
Michelle Schaefer (15:50):
If you're on disability and receiving social
security disability, you qualifyto purchase a Medicare plan and
depends on.
Your zip code and some otherfactors as to what plan you can
purchase, but you have basicallythe same two choices.
You can do a supplement,although you don't get the full
fledged plan G that checks allthe boxes in Oklahoma.
(16:12):
You can only have a Plan A,which just checks some of the
boxes and it's kind ofexpensive, and then a drug plan.
Or you can go to the other sideand do a Medicare Advantage
plan.
David Lowry (16:22):
Michelle, I happen to be the conservator guardian
for my sister who's in a nursinghome.
One of the things that's been areal blessing in my life has
been hospice.
A lot of people when they thinkof hospice, thinks of as end of
life care, and it can certainlybe that always, but not always.
And in this case, they visit herwith the social worker, the
(16:44):
nursing team, check on her acouple of times a week.
They bathe her, they providecertain equipment for her.
Just a bed if she needs it andthings like this.
Where does that fit into thisMedicare program?
Michelle Schaefer (16:58):
Hospice is always covered by Medicare Part
B, no matter what plan you'reon.
Oh, whether you're on anAdvantage plan or original
Medicare, hospice is alwayscovered by Part B.
Don Drew (17:07):
When you say it's covered by Part B, do you mean
it's part of your premium?
You're paying for...
Michelle Schaefer (17:12):
Part of your Medicare coverage no matter what
you have, even if you have anAdvantage, Part B, it'll still
pay for your hospice.
Don Drew (17:18):
Michelle, if a listener lives in the Edmond
area, they have you nearby as aresource, but many of our
listeners live outside ofOklahoma, how can they most
effectively evaluate?
People and organizations likeyours to ensure they're getting
the type of assistance theyneed.
Michelle Schaefer (17:33):
There's a lot of resources.
There's a website called theMedicare Agents Hub and they
vetted some agents.
I'm an agent on that.
You can go on there and type inyour zip code and find a local
agent.
But they're really everywhere.
If you look around in yoursocial media, the things you get
in the mail, there's everythingfrom what they call captive
(17:54):
agents that work for a specificcarrier, and so they're only
selling that carrier's products.
I'm an independent agent.
I represent about sevendifferent companies, about 99
different plans.
So I'm gonna be able to shoparound and offer the best plan
for my clients.
Don Drew (18:09):
Is there a particular certification that people should
look for?
A license or something likethat?
Michelle Schaefer (18:15):
In order to sell Medicare, you have to have
a state life health license forevery state that you're selling
in.
And then you have to pass theAHIP.
You're not getting anappointment with a carrier
unless you pass the, if someoneis selling Medicare, they've
done all that.
You just have to look at.
Where are they coming from?
If they're just captive with onecompany, like a call center, if
(18:35):
you call a certain company'scall center, that's all they're
gonna talk about.
Whereas if you get a licensedlocal agent, we're gonna be
independent and we have a lot ofdifferent options.
Don Drew (18:44):
David, you mentioned earlier something about how
complex is it is to doing yourtaxes, and it seems to me like
what Michelle does is she helpsyou navigate through what is
really a whole lot of unknowns.
Not necessarily hidden things,but not obvious things, and
having just.
Recently gone through this, bothof myself and my wife, where we
are registering.
(19:05):
We had our learning curve waspretty steep just to to figure
it out.
And we actually met withMichelle and she was able to
talk us through some things andhelp us make good decisions.
David Lowry (19:14):
Michelle, I just wanna say that when I first
signed up for Medicare, it wasone of the most nerve wracking
things I think I've ever done inmy life.
Michelle Schaefer (19:23):
I make it easy.
David Lowry (19:24):
Exactly.
And I remember going on the siteand I'm gonna say that the
website's pretty good, reallyhonestly.
They would pull up all kinds of,for instance, Part D and all of
that.
But to be honest, I couldn'tdetermine whether, is this
really a good deal for me?
Is this gonna help me out orshould I be going with this
other one?
And this one seems to be alittle less, but is it gonna,
(19:47):
there were just so many littlevariables there, and so I know
that you are worth every penny.
Michelle Schaefer (19:52):
And you pay nothing to talk to a Medicare
agent.
David Lowry (19:55):
Absolutely.
But some people may say, well,why would I do that?
And it's like, you really needto be doing this.
Michelle Schaefer (20:02):
Well, I can save you a lot of time too.
Sometimes people think they haveto go down to the social
security office to do this.
Who has time to sit there forthree or four hours in the
Social Security office?
Waiting to talk to somebody,whereas I can look at it, I can
go on the website, I can startyour Part A and or B for you,
and just make all that easy.
(20:23):
I can show you how to set upyour billing if you're paying
for your Medicare itself.
I just make it easy from A to Zand I don't get paid for.
Any of that other stuff exceptwriting the policy.
I'm compensated by the companiesI write the policy through, but
all the other stuff before andafter I do just to make the
process easy for you.
David Lowry (20:39):
And thank you for that.
Don Drew (20:41):
Michelle.
Can you talk to us about thesteps that you go through in
order to engage with Medicare?
Michelle Schaefer (20:46):
Sure.
So the first thing everybody,not just people getting ready to
get on Medicare, everybody whogets a paycheck should have an
online social security account.
because you wanna make sure thatyour income is being reported
correctly through all the yearsthat you've worked because.
Is gonna make a difference whenyou do go to collect social
security, that you collect thecorrect amount and that
everybody's reported the rightamount.
(21:08):
But to apply for Medicareonline, you've got to have an
online social security account.
So if you haven't done that,that's step one.
And then you go to socialsecurity.gov.
Tell it.
You wanna start applying forMedicare?
It'll say, do you have a socialsecurity account?
You have to know how to log intoit.
You put in your login, yourpassword.
It just bounces over there.
(21:28):
Checks and bounces right back tothe Medicare application.
You thought a little bit ofdemographic information and
submit it, and it takes two tothree weeks on a good day if
they're all caught up to issueyour Medicare number.
Then once you have a Medicarenumber.
Then you can write the plans.
I can't really write a planwithout a Medicare number, so
(21:49):
sometimes it's a timing issue.
If you are over 65 and you'vestayed on your group plan for a
while, there's a form I needfrom your HR department in order
to verify that you didn't have agap in coverage.
And so then we pick out theplans, and then once the plans
are issued and you get a giantbill from Medicare for the first
three months of premium, so Ican show you how to go online
(22:12):
and set up an online Medicareaccount, which is different from
your online social securityaccount.
Set up a Medicare account, howto see your explanation of
benefits, how to order a newMedicare card, and how to set up
the monthly billing so that youdon't have to pay that big three
month premium all at once.
David Lowry (22:28):
If I'm working with agent A and then I decide to go
to agent B, a person likeyourself and have them look over
all my work and everything.
Michelle Schaefer (22:36):
So I'm happy to look at anybody's policies,
but unless I'm able to writethem a new policy that's the
best thing for them, then I, youwouldn't change an agent for the
new policy.
But if what you have is the bestfor you, I'll, I'm happy to look
at it and say, just keep doingwhat you're doing.
Don Drew (22:55):
While Medicare might not be at the top of your fun
things to do list, it provides acritical piece of your
healthcare.
Whether you are facing 65yourself or helping a friend or
a family member, experts likeMichelle exist to help you
navigate Medicare's complexitiesand find the right kinds of
additional insurance at no costto you.
Don't do what I did and waituntil the last minute to enroll
(23:16):
and find out how to best protectyourself.
Michelle Schafer, you've beenvery helpful to our listeners
and David and I for that matter.
Thank you for joining us onPeaceful Life Radio.
Michelle Schaefer (23:26):
Thank you for having me.
I enjoyed it.
When you go on Medicare, it's kinda like the
(00:02):
first time you walked into acell phone store and said, I'd
like a cell phone.
They said, okay, sir, do youwant an apple or do you want an
Android?
So there's a big fork in theroad.
The Advantage plan companies arevery interested in keeping you
healthy.
So they have what I call a lotof shiny stuff, and they have
dental, vision, chiropracticbeds, just hearing aids, gym
memberships, all that stuff thatyou see on TV and the, the stuff
(00:23):
you get in the mail.
And on the original Medicareside, it costs more a month.
And there's no shiny stuff, butyou go to whatever doctor you
want.
David Lowry (00:32):
That was Michelle Schaefer, our guest today on
Peaceful Life Radio.
She's a licensed independentMedicare agent.
And with me today is Don Drew.
How are you, Don?
Don Drew (00:41):
I'm doing great, David, how was your trip to
Florida?
David Lowry (00:44):
Florida was great.
I recommend that everybody go asoften as possible.
Hey, let's talk about Medicaretoday.
And that's a big topic we allneed to know about.
Why don't you introduce ourguest, Michelle?
Don Drew (00:57):
You bet, David.
Our guest today is MichelleSchafer, a licensed independent
Medicare agent and owner of theSchafer Agency.
She has been a licensed agentsince 1995 and is dedicated to
helping seniors navigate thecomplexities of Medicare.
I.
Based in Edmond, Oklahoma, shebrings a wealth of knowledge and
a compassionate approach to eachclient's unique situation.
(01:17):
With her goal being to make theenrollment process as smooth as
possible.
Michelle is passionate aboutgiving back to others through
service in Rotary International,and has been the director of the
Downtown Edmond Arts Festivalsince 2021.
Michelle Schafer, welcome toPeaceful Life Radio.
Michelle Schaefer (01:33):
Thanks for having me.
Glad to be here.
Don Drew (01:36):
Michelle, I think most people understand that Medicare
is our country's healthinsurance program for people age
65 or older.
There are some other exceptions.
Hopefully we'll get aroundtalking about some of that, but
all of us will eventually needto understand Medicare.
So let's just start there.
What exactly is Medicare?
Michelle Schaefer (01:53):
Medicare is the option for your health
insurance when you're over 65,if you are not currently on a
group plan or other kind ofcoverage that covers you.
Don Drew (02:03):
So after 65, you don't have to go on it at 65 if you
are covered, correct?
Michelle Schaefer (02:09):
Right.
So if you have what's called acredible policy, which most
group plans are, then thatprotects you from having a late
enrollment penalty or not beingable to enroll for a while
because you didn't havecoverage.
So as long as you're on a groupplan, if you don't wanna go on
Medicare, you do not have to.
David Lowry (02:30):
Let's talk about that penalty right there,
because that's a gotcha that youneed to know about.
Michelle Schaefer (02:34):
There are things that are not credible
coverage such as COBRA.
So if a company would let somefolks go who are over 65 and
say, Hey, we're gonna give youthree months of COBRA, and then
they come off to three months ofCOBRA and find out that they
have exceeded their timeline forgetting on a Medicare plan,
that's a problem.
So the easiest way to do it isto go straight from the day the
(02:57):
group plan ends.
Start.
Medicare always starts on thefirst of a future month.
So if the group plan ends on theend of the month, you start
Medicare on the first of nextmonth, and then there's no gaps,
so then there's no penalty.
David Lowry (03:08):
What happens when you're penalized?
Michelle Schaefer (03:10):
It could be that you're not allowed to
enroll until after the first ofthe year.
So you could have no coverage.
And then there's also afinancial penalty that is
permanent and on there foreverand ever.
David Lowry (03:22):
So you really wanna get enrolled when you can.
Timing is critical.
Don Drew (03:28):
I do wanna mention, Michelle is not an expert in
social security per se, butthere is one link to social
security that's pretty importantfor people to understand.
What would that be, Michelle?
Michelle Schaefer (03:37):
If you are getting Social security, your
Medicare premium willautomatically be deducted from
Social Security before it evenhits your bank account.
If you're not on social securitythen you just have to set up a
monthly bank draft with them.
David Lowry (03:49):
Now, as I recall, there was Part A and Part B of
my Medicare, and Part A happenedalmost automatically for me.
I just went online or somethinglike that.
It didn't cost anything.
I just checked the box andsuddenly I got something in the
mail and I have Part A.
But Part B is a different story.
Right?
Michelle Schaefer (04:09):
Medicare is divided into two parts.
So if you think of'A make a roofwith your hands,'A is for under
a roof.
'A covers you in a hospital orin a skilled nursing facility.
And if you have worked 40quarters, 10 years at a certain
income level, your'A costs zero.
So sometimes people when theyturn 65, even if they're still
(04:30):
on a group plan, we'll go aheadand enroll in a, because it
doesn't cost anything and itmight bring their group.
Out of pocket for hospitalcoverage down to$1,600.
'B is everything else.
Your doctor's appointments, yourlab work, your durable medical
equipment.
There is a premium for B.
So you do not need'B and a groupplan at the same time.
(04:52):
It's either or because it's justduplicating itself.
Don Drew (04:56):
And then the other thing I think we hear a lot
about is Part D, right?
Delta.
Michelle Schaefer (05:00):
D for drug.
Don Drew (05:01):
Okay.
Michelle Schaefer (05:02):
Drugs, they give D for drugs.
Don Drew (05:03):
So that's all your prescription, right?
Michelle Schaefer (05:05):
Because Medicare itself, A or B, does
not cover any drug plans, exceptif you go into a doctor's office
for a drug, say an infusionthat's covered under Part B.
But anything you go to thepharmacy and you administer
yourself at home a drug plan.
And the interesting thing withthe drug plan is sometimes
people say, oh, I don't take anydrugs.
(05:25):
Why should I buy a drug plan?
Again, there's a penalty forevery month.
You should have had a drug planand you didn't.
There is a permanent lifetimepenalty and that penalty
increases every month you don'thave a drug plan than you should
have.
David Lowry (05:40):
I'm glad we're talking to you because it can be
very confusing, but fortunatelythere are people like you,
Michelle, out there.
What are our choices when wesay, okay, I gotta have this and
I know I've gotta have Part B?
Yeah.
How you start all this?
Michelle Schaefer (05:55):
When you go on Medicare is kinda like the
first time you walked into acell phone store and said, I'd
like a cell phone.
They said, Okay sir.
Do you want an apple or do youwant an Android?
So there's a big fork in theroad.
You have to make this decisionfairly early about which way
you're going.
And just like Apple and Android,there's no wrong decision.
The best plan is the one thatworks for you.
I will always present both sidesof it.
(06:17):
They both have advantages.
They both have disadvantages.
You pick the best plan thatworks for you.
So there's a big decision to bemade.
One is original Medicare, so youhave your'A and your'B.
But there's a lot of thingsthose plans don't pay for.
So what most people do is get asupplement.
So a supplement works hand inglove with Medicare and will pay
what Medicare doesn't, exceptfor a very tiny deductible of
(06:39):
$257 a calendar a year.
And then you wanna add a drugplan.
because none of those cover drugplans.
So that's.
That's one side of the decision.
The other side is an advantageplan.
So what an advantage plan doesis Medicare pushes your files
across the table to an insurancecompany and says, here, you take
care of him.
We're gonna give you some moneyevery month, and then we're
(06:59):
done.
The Advantage plan companies arevery interested in keeping you
healthy.
So they have what I call a lotof shiny stuff.
So they roll in the drug plan.
They have dental, vision,chiropractic, podiatrist,
hearing aids, gym memberships,all that stuff that you see on
tv and the stuff you get in themail.
And the premiums on those can bezero.
They're very, very low premium.
(07:21):
However, you have to use thedoctors in the network.
When you're on the supplementside, any doctor who takes
Medicare will take that.
But on the advantage side, youhave to be in a network and
there could be some largeout-of-pocket costs if you do
some things that the plandoesn't fully cover.
Whereas a supplement you're keptout at for this year,$257.
David Lowry (07:42):
People are going to wonder what the advantages of
each of them are.
I'm certainly not verbose enoughto tell you what all those are,
but I do know that when I waslooking at one plan, it reminded
me of when I was at work, I hadthe healthcare plan offered by
my job, and it looked verysimilar to what I'd been having
all these years, and that wasthe Medicare Advantage plan.
(08:03):
And so it was attractive to mebecause I was used to going to a
certain place, certain doctorsand being covered.
Plus it had the gym membershipand that was pretty sexy too.
Then on the other side, itseemed to me like I had more
flexibility of doctor choices ifI went with the standard
Medicare.
I could choose who I wanted aslong as they would accept
(08:25):
Medicare.
Are there other advantages anddisadvantages that I'm missing
here?
Michelle Schaefer (08:29):
No matter what, you're gonna pay your Part
B premium.
Yeah.
No matter which path you godown, you're paying your Part B
premium, so that levels thatplaying field on your Part B
side.
One of the disadvantages is withthe supplement, you're paying a
premium every month, and itcould be anywhere from a hundred
to 150, depending on your ageand your zip code.
(08:50):
If you smoke and if you haveanother adult human living with
you in the household, there'sjust different discounts you can
get.
There's no shiny stuff and youmentioned the shiny stuff, the
gym membership and all that.
On the original Medicare side,it costs more a month and
there's no shiny stuff, but yougo to whatever doctor you want.
On the advantage side, premiumis really, really low.
(09:11):
Includes the drug plan, the gymmemberships, and the fitness,
and the over the countervitamins.
They wanna keep you healthy, sothe premium's really low.
However, you have to be sure youuse the doctors in the network
and.
If you have chemo drugs or haveto go on dialysis, or you have
an extended nursing home stay,you can have up to a$5,000 per
(09:32):
calendar year out of pocketexpense if something happens.
David Lowry (09:35):
On the Medicare Advantage plan, are there
certain things that they'reallowed to say, We don't cover
that?
Michelle Schaefer (09:41):
An advantage plan has to cover all the stuff
that Medicare itself covers.
Oh, okay.
I can't skimp on that, but it'svery flexible what they can add
in.
And that changes every year.
Some years there was anadvantage plans that gave you
cash back on your Part B.
There was some that gave you bigover the counter allowances.
(10:01):
Those flex every year, dependingon the market as an agent, we
don't find that out until Augustand September.
We cannot talk about it untilthe 1st of October, and then we
have your annual enrollment inthe fall when they make all that
Medicare noise, that's the timewhen there are some plans you
can hop from plan to plan ifthere's a better plan.
Don Drew (10:21):
Michelle, we've mentioned that Medicare doesn't
cover some things.
I'm sure that list is long andthey can probably go online and
see what that is, but what aresome of the things that they
don't cover that generally catchpeople off guard or surprise
them?
Michelle Schaefer (10:36):
So of course there's no dental in medicare.
Medicare will cover anythingthat is medically necessary.
So if your doctor says, Hey, weneed you to go to the labs and
check your cholesterol and checkyour vitamin D three and check
your blood sugar, Medicare'shappy to pay for that.
But if you go in and just say,let's run all the tests, let's
just go to the lab and run'emall.
(10:56):
Medicare's not gonna pay forthat because it's not medically
necessary.
Where people get caughtsometimes is you need cataract
surgery.
That's a medical procedure.
Medicare's happy to pay forbasic cataract lenses, but but
if you want the bionicc lenses,you're gonna have to pay for
that.
And your doctor's billingsoffice are really good about
telling you here's what's gonnabe covered and here's what
(11:18):
isn't.
Don Drew (11:19):
I'm glad you brought that up because I've been on
Medicare two years I think, andI got caught right away.
I had a situation in which, inmy annual physical, I was used
to have meeting the doctor,getting my blood work done, and
then I lost my chance to talk tothe doctors.
So I called him up and I said,can you go ahead and schedule
him the test ahead of time so Icould talk to the doctor during
the visit?
I ended up paying severalhundred.
(11:40):
Of dollars for that because itwasn't requested by the doctor.
Michelle Schaefer (11:44):
Your doctor's billing office will be able to
tell you that because that'swhat they do.
But you said it might be a longlist.
It's really not.
David Lowry (11:50):
The main thing is don't count on that being paid
for until you talk to yourdoctor.
Wow! There is so many nuances toMedicare and I guess a person
could shop around and make thishappen.
But it's like doing your owntaxes, isn't it?
You can do it if you want.
But let's talk about why anagent is a useful experience for
(12:13):
people who are looking atMedicare and trying to stay on
top of their needs.
Michelle Schaefer (12:17):
For one, our training.
Every year in August, we have tostudy countless hours and take a
big test called an AHIP test tobe certified as a Medicare
agent.
And then we spend countlesshours with each of our carriers
learning about their plans.
And there's online training andthere's in-person training and
there's conferences that we goto.
(12:38):
So a lot of training.
And you're right about thenuances.
It's like every rule has anexception, but every exception
has an exception.
And if you're not aware of allthe little rules you could get
caught.
So yes, a person could go onlineand spend hours and slog through
it themselves and figure it outand hope they did it right.
At the advantage of an agent isnumber one, our training.
(13:00):
Number two, it costs you nothingto talk to an agent.
We're gonna write probably aboutthe same policy as you would do
it online, but the big thing iswe're gonna keep an eye out for
you.
So in the fall, when I find outthat those policies have
changed, I can call my peopleand say, Hey, I'm looking down
the road.
You are gonna want a differentpolicy come January 1st, so
let's fix that.
(13:21):
Whereas if you just call an 800number, you go online and do it.
Nobody's watching out for you.
Whereas an agent.
Cost you nothing to work withand we're gonna take care of
you.
Don Drew (13:30):
Can we talk about how much all of this is gonna cost?
There's a general Medicare costfor Part B, I believe.
But this was another surprise Igot was something called IRMA.
What is Irma all about?
Michelle Schaefer (13:40):
So in 2025, the Medicare premium for Part B
is$185, and that is set everyyear by the Center for Medicare
is what we call CMS, the Centerfor Medicare Services.
So that is set, and we'll findout in the fall what that is.
Every year the deductible is setby them and it goes up.
(14:01):
Every year.
Year.
I just pretty much guarantee youthat.
So your base Medicare Part Bpremium is 185.
Then there's a thing called Irmawas the income reduction monthly
Medicare amount.
And that just says the more youmake, if you are blessed to be a
higher income earner, you'regonna pay more for your Medicare
premium.
It could be about$75 more.
(14:21):
It could be$185 more.
It could be$400 a month more.
It just depends.
The asterisk there is if you'vehad a life change, say you've
retired, you were a high incomeearner, and they look back two
years, by the way.
So if you go on Medicare in 25,you're gonna look at your 2023
tax return line two A, which isyour federal tax exempt
(14:42):
interest, and line 11, which isyour adjusted gross income.
That's the only two things theylook at, and so if you say,
well, I did make this much, butnow I'm retired and I make zero,
I can help you turn in arebuttal form and say, Hey,
there's been a life change.
My income is no longer this.
Don't charge me the penalty.
David Lowry (15:03):
If you file together, is it the adjusted
gross income of both of you?
Michelle Schaefer (15:07):
Right.
Most people who are marriedfollow jointly, and it goes off
of that.
David Lowry (15:11):
Gotcha.
So when you fully retire andhang it all up, that could reset
things for you a bit dependingon how much you're bringing in
at that point.
That makes sense.
Michelle Schaefer (15:20):
They evaluate that every year, which is why
you start Medicare at SocialSecurity's website and not
Medicare's website because ofthe income factor.
Don Drew (15:30):
Michelle, if we could, I'd like to talk about some of
the other ways Medicare canhelp, such as in cases of
disability and so forth.
I know there's a lot of othersituations in which Medicare
kicks in that isn't based solelyon turning 65 and so forth.
What are some of thosepossibilities for our listeners
that might have use of Medicarebut don't fit that model?
Michelle Schaefer (15:50):
If you're on disability and receiving social
security disability, you qualifyto purchase a Medicare plan and
depends on.
Your zip code and some otherfactors as to what plan you can
purchase, but you have basicallythe same two choices.
You can do a supplement,although you don't get the full
fledged plan G that checks allthe boxes in Oklahoma.
(16:12):
You can only have a Plan A,which just checks some of the
boxes and it's kind ofexpensive, and then a drug plan.
Or you can go to the other sideand do a Medicare Advantage
plan.
David Lowry (16:22):
Michelle, I happen to be the conservator guardian
for my sister who's in a nursinghome.
One of the things that's been areal blessing in my life has
been hospice.
A lot of people when they thinkof hospice, thinks of as end of
life care, and it can certainlybe that always, but not always.
And in this case, they visit herwith the social worker, the
(16:44):
nursing team, check on her acouple of times a week.
They bathe her, they providecertain equipment for her.
Just a bed if she needs it andthings like this.
Where does that fit into thisMedicare program?
Michelle Schaefer (16:58):
Hospice is always covered by Medicare Part
B, no matter what plan you'reon.
Oh, whether you're on anAdvantage plan or original
Medicare, hospice is alwayscovered by Part B.
Don Drew (17:07):
When you say it's covered by Part B, do you mean
it's part of your premium?
You're paying for...
Michelle Schaefer (17:12):
Part of your Medicare coverage no matter what
you have, even if you have anAdvantage, Part B, it'll still
pay for your hospice.
Don Drew (17:18):
Michelle, if a listener lives in the Edmond
area, they have you nearby as aresource, but many of our
listeners live outside ofOklahoma, how can they most
effectively evaluate?
People and organizations likeyours to ensure they're getting
the type of assistance theyneed.
Michelle Schaefer (17:33):
There's a lot of resources.
There's a website called theMedicare Agents Hub and they
vetted some agents.
I'm an agent on that.
You can go on there and type inyour zip code and find a local
agent.
But they're really everywhere.
If you look around in yoursocial media, the things you get
in the mail, there's everythingfrom what they call captive
(17:54):
agents that work for a specificcarrier, and so they're only
selling that carrier's products.
I'm an independent agent.
I represent about sevendifferent companies, about 99
different plans.
So I'm gonna be able to shoparound and offer the best plan
for my clients.
Don Drew (18:09):
Is there a particular certification that people should
look for?
A license or something likethat?
Michelle Schaefer (18:15):
In order to sell Medicare, you have to have
a state life health license forevery state that you're selling
in.
And then you have to pass theAHIP.
You're not getting anappointment with a carrier
unless you pass the, if someoneis selling Medicare, they've
done all that.
You just have to look at.
Where are they coming from?
If they're just captive with onecompany, like a call center, if
(18:35):
you call a certain company'scall center, that's all they're
gonna talk about.
Whereas if you get a licensedlocal agent, we're gonna be
independent and we have a lot ofdifferent options.
Don Drew (18:44):
David, you mentioned earlier something about how
complex is it is to doing yourtaxes, and it seems to me like
what Michelle does is she helpsyou navigate through what is
really a whole lot of unknowns.
Not necessarily hidden things,but not obvious things, and
having just.
Recently gone through this, bothof myself and my wife, where we
are registering.
(19:05):
We had our learning curve waspretty steep just to to figure
it out.
And we actually met withMichelle and she was able to
talk us through some things andhelp us make good decisions.
David Lowry (19:14):
Michelle, I just wanna say that when I first
signed up for Medicare, it wasone of the most nerve wracking
things I think I've ever done inmy life.
Michelle Schaefer (19:23):
I make it easy.
David Lowry (19:24):
Exactly.
And I remember going on the siteand I'm gonna say that the
website's pretty good, reallyhonestly.
They would pull up all kinds of,for instance, Part D and all of
that.
But to be honest, I couldn'tdetermine whether, is this
really a good deal for me?
Is this gonna help me out orshould I be going with this
other one?
And this one seems to be alittle less, but is it gonna,
(19:47):
there were just so many littlevariables there, and so I know
that you are worth every penny.
Michelle Schaefer (19:52):
And you pay nothing to talk to a Medicare
agent.
David Lowry (19:55):
Absolutely.
But some people may say, well,why would I do that?
And it's like, you really needto be doing this.
Michelle Schaefer (20:02):
Well, I can save you a lot of time too.
Sometimes people think they haveto go down to the social
security office to do this.
Who has time to sit there forthree or four hours in the
Social Security office?
Waiting to talk to somebody,whereas I can look at it, I can
go on the website, I can startyour Part A and or B for you,
and just make all that easy.
(20:23):
I can show you how to set upyour billing if you're paying
for your Medicare itself.
I just make it easy from A to Zand I don't get paid for.
Any of that other stuff exceptwriting the policy.
I'm compensated by the companiesI write the policy through, but
all the other stuff before andafter I do just to make the
process easy for you.
David Lowry (20:39):
And thank you for that.
Don Drew (20:41):
Michelle.
Can you talk to us about thesteps that you go through in
order to engage with Medicare?
Michelle Schaefer (20:46):
Sure.
So the first thing everybody,not just people getting ready to
get on Medicare, everybody whogets a paycheck should have an
online social security account.
because you wanna make sure thatyour income is being reported
correctly through all the yearsthat you've worked because.
Is gonna make a difference whenyou do go to collect social
security, that you collect thecorrect amount and that
everybody's reported the rightamount.
(21:08):
But to apply for Medicareonline, you've got to have an
online social security account.
So if you haven't done that,that's step one.
And then you go to socialsecurity.gov.
Tell it.
You wanna start applying forMedicare?
It'll say, do you have a socialsecurity account?
You have to know how to log intoit.
You put in your login, yourpassword.
It just bounces over there.
(21:28):
Checks and bounces right back tothe Medicare application.
You thought a little bit ofdemographic information and
submit it, and it takes two tothree weeks on a good day if
they're all caught up to issueyour Medicare number.
Then once you have a Medicarenumber.
Then you can write the plans.
I can't really write a planwithout a Medicare number, so
(21:49):
sometimes it's a timing issue.
If you are over 65 and you'vestayed on your group plan for a
while, there's a form I needfrom your HR department in order
to verify that you didn't have agap in coverage.
And so then we pick out theplans, and then once the plans
are issued and you get a giantbill from Medicare for the first
three months of premium, so Ican show you how to go online
(22:12):
and set up an online Medicareaccount, which is different from
your online social securityaccount.
Set up a Medicare account, howto see your explanation of
benefits, how to order a newMedicare card, and how to set up
the monthly billing so that youdon't have to pay that big three
month premium all at once.
David Lowry (22:28):
If I'm working with agent A and then I decide to go
to agent B, a person likeyourself and have them look over
all my work and everything.
Michelle Schaefer (22:36):
So I'm happy to look at anybody's policies,
but unless I'm able to writethem a new policy that's the
best thing for them, then I, youwouldn't change an agent for the
new policy.
But if what you have is the bestfor you, I'll, I'm happy to look
at it and say, just keep doingwhat you're doing.
Don Drew (22:55):
While Medicare might not be at the top of your fun
things to do list, it provides acritical piece of your
healthcare.
Whether you are facing 65yourself or helping a friend or
a family member, experts likeMichelle exist to help you
navigate Medicare's complexitiesand find the right kinds of
additional insurance at no costto you.
Don't do what I did and waituntil the last minute to enroll
(23:16):
and find out how to best protectyourself.
Michelle Schafer, you've beenvery helpful to our listeners
and David and I for that matter.
Thank you for joining us onPeaceful Life Radio.
Michelle Schaefer (23:26):
Thank you for having me.
I enjoyed it.
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On Purpose with Jay Shetty
I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!