Episode Transcript
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Speaker 1 (00:03):
Hi. Tryan Thomas normally hosts of the fifty five Casey Morning
Show from five to nine am Monday through Friday. But
I get the opportunity and I enjoy my conversation with
John Rohlman of Cover since every Sunday at this time
we rethink healthcare together, and I'm glad you're able to
tune in. Got some important things to talk about today. Notably,
we're going to focus on medicare. We've talked about this
topic before, but John and his team are medical insurance specialists.
(00:27):
Always like to emphasize they're working for you with access
to hundreds of insurance companies and thousands of different policies,
but he's always thinking about your best interest and looking
at where you are in life. Last week we talked
about the different stages of life and how important it
is to take a look at your coverage. You know,
if you're just newly married, the kids coming along, kids
are teenagers, you're getting ready to retire, and so moving
(00:48):
to that latter category, you're getting ready to retire. Medicare
certainly is a part of the discussion, and John's got
a lot of important information to passing along to you
on the subject. Of medicare, John, it's always place as
you're talking with you on a Sunday morning. Oh you too, Brian.
So we've been down this road before, and I know
your phone starts ringing off the hook every time you
and I bring up this topic. But it's so important
(01:12):
to do it, right. I mean, you just get to
that age. I'm on medicare now, but there's a lot
of layers and complexities and components that go along with that,
and a lot of things that people need to think
about in advance. Oh. Absolutely.
Speaker 2 (01:23):
I mean Medicare for most people, Brian, is just completely foreign, right,
because most people have had their health insurance taken care
for them, right, They've been an employer, right, they just
like pick option one, two or three, Okay, this is
the one I want. That's it, right, So they don't
really understand in a lot of cases how insurance works.
And number two that they have a lot of options
(01:43):
and it really confuses them. And I've seen the Medicare
and You book that these guys get. It is like
eighty pages and they just literally use it as a
weight on their coffee table. They can't get through it.
They don't understand it. It's just it's written I think
to be confusing. And you know it's funny because when
they call in to talk to me my representatives, that
(02:04):
basically endser the phone. I've had to train them how
to walk clients through to make sure they're set up
so when I meet with them, I can help them.
And that's I mean, so many people call in they're like, hey,
I'm I'm a Medicare. I just got it last month,
and you know, I need to talk to John about
what else I need to do. And then we find
out they're not even set up yet, like they didn't
get their part b you know, they don't even have
(02:24):
their documentation set in right. I mean, there's so many people.
I would say probably three and every five people that
call in aren't set up the right way, really yeah,
or don't know what they need to do, and so
we're really doing a lot of education. Before I didn't
even talk to me to make sure they got every
other ducks in a row. But really, it's kind of
the purpose of the show today is you've listen. If
(02:46):
you listening to this, or you're a year out or
currently like ready to get on Medicare or already on it,
you know and like, oh, I didn't realize I didn't
have that. You know, the goal here today is you know,
talking about making sure you can pick the right plan,
you know, and avoiding penalties.
Speaker 1 (03:00):
That's all that word. I was getting ready to bring
that up. So folks stick around because there's some pitfalls. Yeah,
they involve penalties.
Speaker 2 (03:07):
And of course protecting your future health and fitness and
finances right you know. So it's like that just makes
more sense to because so many people don't realize like
oh I got A and B and I'm good, and
then they realize they are all kinds of holes and or
they're in a long term care situation and running out
of money, or you know, now they're tapping into all
their reserves and nested because they didn't do the right thing.
(03:28):
So this is why it's so important to really listen
to day. So again, you know, this is for people
that are already on medicare, you know, if you're turning
sixty five, or maybe you're an adult child just kind
of helping your parent kind of go through that situation.
This is really, you know, the nice thing about it
because again, medicare is not free. You know, it's not
(03:48):
simple and getting it wrong can be extremely costly. Right,
So again let's kind of get in through the the
what I call the four parts of medicare and the
basics you really need to know. So again, Part A
is what you get at sixty five. Now again you
have to make sure you enroll into these type of
things because you got to get documentation and notices. You know,
(04:12):
Center for Medicare Services has to be updated on like
your physical address where you actually live. Well, I got
two addresses. I have a part time place that I
live in Florida. Like you need to make sure your
place here in Ohio where you're at as your primary,
you know, and make sure that's all set up the
right way. And usually Part A is free all right,
so long as you work ten years. And they talk
about like the forty credit quarters or whatever that you
(04:34):
have to go through. We just had a client the
other day. They the spouse, the wife she's never worked,
her husband's always worked, paid into medicare, and I guess
he ended up passing away. And so she went to
go apply for her medicare and they basically told her
she didn't have enough time worked. And I was like,
she wor and she didn't, but but she did because
(04:56):
her husband didn't. Oh so when you're married, the husband
paying in sat ASFI as your Medicare. So I got
so guess who had it wrong? Medicare? So she was ready, Yeah,
really had it wrong. So we had to help her
walk through that scenario so that she could get her
Medicare for part eight for free. I was one of
the things we had to do because she was so
confused thinking that they I think they sent her a
(05:17):
bill for like six hundred and eight hundred bucks or
something like that.
Speaker 1 (05:19):
A month.
Speaker 2 (05:20):
She said, I can't afford this. I was like, you
do you don't. I don't think you have to pay this.
Let's let's walk you through your head to do this.
We really help her. So again, typically parties free, but
there are scenarios and we can help you get through
that if if they're telling you something differently. Part B
all right is your outpatient cover. So basically, anything you
do outside of the hospital all right is your Part B.
You have to elect to get into this all right,
(05:43):
and it's extremely important that you do that because there
there's penalties if you don't do it all right. But
Part B is your outpatient cover. So anything outside of
the hospital. If you don't take Part B, anything outside
of going into the hospital, you will be paying one
hundred percent on which is going to be about eighty
percent of your potential claims.
Speaker 1 (05:59):
So careful, but going to see your cardiologists, going.
Speaker 2 (06:02):
To see your cardiologist, or having an outpage and procedure,
you know, having a diagnostic like NMRI. So like listen,
all stuff you're doing outside of the hospital. These are
outpatient charges. Be very careful here. But there is a
premium to this, Okay. I don't care which plan you're on.
If you take an advantage plan, if you do anything else,
you're paying for Part B premium and again depending upon
your situation. That's why it's so important to talk to us,
(06:25):
you know, by planning your finances before you turn sixty
five and make sure you're a good spot. The government
loves to charge us more money if we make more money,
so there could be I've seen people pay five six
hundred dollars a month more for Part B because they
didn't get their their their their stuff situated the right
way and decide to sell a big old property right
before and pay all kinds of taxes on it and
then another another get stuck in an IRMA situation. So again, listen,
(06:49):
you can look it up if you have to. If
you're a husband and wife and you're making typically less,
I think it's like two hundred and five two hundred
and fifteen thousand dollars a year. This doesn't come into
your realm, but it is a good conversation to have.
You know, if you're at that level, there's ways that
I can help you get that down. I know how
to work with the government and get these things taken
care of. So that's why it is so important to
(07:09):
kind of work with someone that is in that realm,
because Medicare can be very costly if you're doing it
the wrong way. Part D, so again, Part b's optional
but highly recommend it. Part D is also optional but important.
Part D is your prescription drug coverage. Okay, it is
very important that you pick up a prescription drug plan
because without it, you can only enroll in this once
(07:31):
a year. You can't be like, well, it's July, I'm
not on a prescription but if I start one next month,
I can get on. It doesn't work that way. You
can only do it during the open rollment each year.
So you be very careful. There's also a penalty if
you don't take it out. And then Part C, which
is kind of in between the B and D. You know,
that's where you go with a private insurance company and
there's a couple options. We'll get into that as far
as what you're going to do to that. But again
(07:52):
remember Medicare doesn't cover everything. Medicare doesn't cover dental, they
don't cover vision, they don't cover hearing, and guess I'll say,
don't cover Brian.
Speaker 1 (08:00):
Long term care term care.
Speaker 2 (08:01):
Right, so if you are at a facility or needing
a nurse to come take care of you at your house,
Medicare doesn't pay for that, all right, So again think
about Medicare is basic coverage. It is not full protection.
I always say, anything the government's gonna give you is
gonna have holes. And there's some big ones when it
comes to Medicare, And so making sure you do it
the right way and sit down with something like really
(08:22):
an expert in that field and can give you all
the options so that you can make a good decision.
That's so important this point, and really get you through
all the fluff, right, there's so much fluff out there.
I love Medicare season because I get to see all
my ex favorite football players come on TV and talk
about the companies that they're you know, sponsoring and invested in.
(08:44):
You know, it's like, oh, look, that guy's seventy years old.
Then I remember when he used to play football, So
my dad would tell me that. And you know, those
are the guys kind of pushing plans. You know, if
they're pushing plans, typically I'll tell you it might not
be the one you really want.
Speaker 1 (08:58):
They get paid, I'm sure it probably ansombly to push.
Speaker 2 (09:00):
Most of them are investors in those companies.
Speaker 1 (09:02):
Oh great. So three most.
Speaker 2 (09:05):
Common and costly medicare mistakes right number one missing your
enrollment period. Guys, this is so important. You have a
long time to do it. So you have three months
before your sixty fifth birthday, the month of your sixty
fifth birthday, and three months after to get this all
taken care of. So you have like a seven month window. Okay,
(09:26):
so there's plenty of time to get things done. Don't
fret last minute. I can help you in any realm.
But this is so important to like start having that
conversation three or four months before your sixty fifth birthday,
so that we get it all taken care of the
right way. And even if you've got number one, even
if you've got Medicare early. I got a lot of
people that are on disability, like in their fifties, they're
on Medicare disability for whatever reason. Re look at it
(09:46):
at sixty five because there's more options. You don't have
a lot of options when it comes to under sixty
five for Medicare of supplements and Medicare advantage plans. You
get all the options when you turn sixty five. I've
help so many people get way better covered so they
couldn't get when they're on medica your disability. They turned
sixty five, they got lights out coverage like because they
were able to get more options. So again, relooking at
(10:06):
that at your sixty to birthday is so important.
Speaker 1 (10:08):
Right, Let's give people the bad news.
Speaker 2 (10:09):
Yeah, the bad news here Medicare Part B penalty. So
every year you don't take a Medicare Part B it
is a ten percent penalty each and every year that
lasts you the rest of your life.
Speaker 1 (10:23):
You can't unring that bell, can't ring it. There's not
something I can do.
Speaker 2 (10:26):
So if you didn't pick up your Part B and
you just turned seventy years old, you're five years in.
You're paying fifty percent more for that for the rest
of your life, and this year it's one hundred and
eighty five bucks, so you know you're paying that plus
fifty percent, So another ninety dollars a month added to
that for the rest of your life for the same thing.
(10:46):
Everybody else is getting it for fifty percent cheaper. So
making sure you do it now. If you have credible coverage,
you're still working through an employer, and it's considered credible,
you don't have to opt to Part B. So many
people buy Part B and they're still working and they
have group health benefits. Guys, you don't have to buy it.
Don't pay the extra money. It's really not going to
do much for you, so you don't have to buy it.
If you have any questions, that give us a call.
(11:07):
You can see if that makes sense for you.
Speaker 1 (11:08):
To have incredible coverage during that So if you're still working,
then you're not going to be subject to the ten
percent penalty when you roll later.
Speaker 2 (11:15):
Correct okay, correct, correct if it's credible, we'll get to
that in a minute, all right, So again, staying on
your employer coverage too long, especially risky at small companies
less than twenty employees, just because a lot of these
companies might not have credible coverage. So one of the
biggest things we saw this last year was that credible
coverage has to be where you don't have an out
(11:36):
of pocket expense for prescriptions more than two grand. Most
people's health insurance plan out of pocket is more than
two grand. Oh really yep, So one of the rule
changes for last year, and they extended it into this
year because they didn't want to do the penalty right away.
But this year, we don't know if they're going to
remove that, and I'm not hearing that they are. So
what basically that means is if you're on an employer
group plan and your prescription out of pocket is more
(11:58):
than two grand on your plan, it's not considered credible
and then you're going to be subjucated to those penalties.
And you'll typically see this on groups less than twenty
employees because the coverage is usually aren't very good there.
So again something to really think about. If you're like
sixty six, sixty seven years old, like, well, I'm gonna
probably keep working. You do not want to be coming off,
and then we have to turn around and tell you,
I'm sorry your plan was not considered credible through your group.
(12:19):
Even though you were working there and get paying for
group benefits, you're still subjucated to the penalty. So it
is a really good conversation to have because I don't
want to see you coming in and tell you sorry, ma'am,
you got to pay forty percent more. You know, so
really really important choosing a Medicare advantage plan without understanding it. Listen,
I see these people, we sell them. I'm literally doing
(12:40):
this certification to do Medicare advantage plans right now. We
help so many listeners in the area last year that
I am training my.
Speaker 1 (12:47):
Entire office how to do it.
Speaker 2 (12:49):
I would just me and one other my agents last
year because we didn't realize how many people needed help.
We had so many people call in, so many people
that we help. I'm training my entire salesforce this year
on Medicare advantage and most of it is to help
these individuals change their plans from plans other people had
them set up on that was not perfect for them.
So we had to make a lot of changes a
(13:09):
lot of people are on HMOs, and I highly suggest
you don't be on one. You look down at your
insurance card right now, open up your wallet. Look at
your insurance card. If it says XYZ insurance company and
it says HMO, please schedule an appointment with me in
September for October so we can really look at it.
You probably need a PPO. We saw so many doctor
networks leave last year in the middle of the year
(13:30):
that's moved HMLO right away. HMO is going to be
the most restrictive, and listen, you probably shouldn't be there.
And I always say I don't want to put my
worst enemy in HMO, so I'm probably going to recommend
something else. I'm going to show you an alternative so
that you don't lose your cardiologists or your primary care
in the middle of the year because they decided to
be in a contract to speak with the insurance company
(13:51):
and no longer in there. We saw the Lender Center
leave major insurance company last year, saw Christ's Hospital. I mean,
I see huge Saint Eves. I've seen happen even the
middle of Medicare advantage open enrollment, Like you need to
be protected guys, you can't make a change till the
end of the year. Don't be without the people that
you need for an entire year because you took the
(14:11):
wrong plan. So again, low premiums right, that they sell
you on the zero premium options, and the low premiums
doesn't mean it's good coverage.
Speaker 1 (14:21):
Right.
Speaker 2 (14:21):
Many of these plans have huge out of pocket expenses
and you know, can be over eight grand, you know,
if you're doing the wrong thing. So there's I always say,
there's no free lunch. There's a catch, and we want
to talk about those catches and see if they make.
Speaker 1 (14:33):
The most sense for you.
Speaker 2 (14:35):
So again, Medicare advantage.
Speaker 1 (14:36):
You know.
Speaker 2 (14:37):
The nice thing about it, it does combine your AB
and D, but you're also losing your original Medicare. And
what does original medicare give you, Brian, access to every
doctor in hospital the United States? It takes Medicare, right.
I always talk about places like M d Anderson because
I know if any of my family members have got cancer,
I'm running down there. It's one of the best cancer
hospitals in the world. I want the best treatment in
(14:59):
those situations, you know. And if I haven't metcare advantage plan,
I can't go there, you know, so something something to
really think about. Right, it's you know, but it does
combine everything. So what happens to the Medicare advantage plan.
You're basically giving up your original Medicare and everything's flowing
through to an insurance company. Right, So they're going to
be able to start making those decisions. They're gonna say, hey, referral,
(15:22):
referral prior off, prior off, right, I mean they're gonna
start going, oh, you can't go there, or like I
just said, oh, we're not, we don't take that doctor anymore.
So it puts you into a really it can put
you into a really bad situation, you know, if you're
not doing the right thing, and the out of pocket
expenses on these plans are getting higher. I was doing
one of the states in the northeast, I think it
(15:43):
was a New Jersey where I'm from originally, and I
was looking at some of the out of pockets in there.
It was like ten grande. I was like wow, I
was like, these are really really high. Obamacare ninety two hundred,
they're going up a ten grand this year for twenty
twenty six. So yeah, I mean it's a but again,
just kind of really understand that situation, and especially if
(16:04):
you're turning sixty five and have some medical issues, Medicare
advantages doesn't mean it's the best option for you. I
mean really, sometimes it's better off to pay and get
yourself a meta gap plan, which is next thing we'll
talk about. Because you're out of pocket, expenses are far less,
so medi gap or Medicare supplement. This is what my
parents are on, and for most of my clients, you know,
this is where they ended up going. I would say
(16:24):
Medicare advantage is probably about twenty five percent of the
actual business that we do through our office. About seventy
five percent of our clients are on Meta gap or
Medicare supplement plans. But it works alongside your Medicare A
and B, So basically it's a supplement. Just how we
sell coverage for the under sixty five market. We add
this to your plan and it gets rid of all
those holes, right, and you have nationwide access. That's what's huge.
(16:47):
I mean, go anywhere you want you travel. Hey, you
plan on retraveling at retirement at sixty five, do you
want to just stay in the greater Cincinnati area or
do you want to go to Florida or maybe take
a trip in the Caribbean or wherever it is. Care
something that's going to do a lot better for you
because you can go anywhere you want with no restrictions as.
Speaker 1 (17:04):
Long as the doctor takes Medicare, as long.
Speaker 2 (17:05):
As they Medicare. I haven't run to one hasn't okayough,
But I mean yeah, I mean you're talking about like
nine to nine point nine percent of the doctors and
hospitals that are out there you can go to. Again,
predictable costs, little higher premiums. We're are seeing a little
bit of a tick up in this realm. You know,
if you're listening this right now, all that this this
is me. I'm going a Medicare supplement. Look at your
(17:26):
pricing right now.
Speaker 1 (17:28):
COVID.
Speaker 2 (17:29):
We just saw the COVID pricing here hit last quarter.
So everything that happened during COVID, all the insurance companies
finally did their Actu Royal science and started raising rates.
If you've seen a significant rating increase, I'm talking about
anything over twenty bucks, give us a call. I have
like forty different medicare supplement companies I work with. I
have the cheapest options, and a lot of times you're
(17:49):
fairly healthy, I can just switch you to the same
plan you're with because it's exactly the same coverage and
save you money. We just talked to a client. We
saved there eighty bucks a month, oh by moving her
to the exact same coverage a different carrier one thousand
bucks a year, Brian, same as that coverage, no difference,
it is you know, so again you can re look
at this and reashop them.
Speaker 1 (18:08):
Right.
Speaker 2 (18:08):
It's it is predictable as far as costs. Right, if
you're turning sixty five right now, I tell people, don't
really overthink the coverage. Look at Option G. So with
Medicare supplements, you have a through N letters right and
are your plan options? Plan G is the best plan.
Plan G covers all those out of pocket expenses that
Medicare has, thills, all those holes except one the part
(18:31):
be deductible and this year's deductibles two hundred and fifty
seven dollars. So imagining getting on Medicare and knowing the
most I can pay going to a doctor or having
an MRI or anything that I do with two hundred
and fifty seven bucks a year, it is the best coverage.
Speaker 1 (18:46):
You'll ever have. Yeah, I've heard you say that.
Speaker 2 (18:47):
You can literally go in the hospital pay nothing if
I set you up like this. So Plan G is
the best option out there. It's really affordable in our
area right now. And especially you have some medical issues.
You're guaranteed issue TEED acceptance right now. When you turn
sixty five, they can't look at your medical history. So
we have so many people to call in and they're like, hey, yeah,
I got all this kind of going on. I need
to have a knee replacement surgery. I say, don't overthink it.
(19:10):
I'm putting in a Medicare supplement and you're to pay
two hundred fifty seven dollars to the new NIE and
nothing for the therapy after that. So yeah, I mean,
this is this is a great situation. Uh, just I
just want to hit on this. From whatever I'm seeing
is doctors love to recommend people start getting testing done
right before they go on Medicare. Please push that off.
Do not be going in getting a colonoscould be two
(19:32):
months before you go on Medicare. I mean it's a
money grab, absolutely. I've told five of my clients in
the last year they called me and told me, my
doctor just recommend I get at Colonoscarby. I'm like, okay,
and like two months you go back. No, he wants
me to do it next month. I'm like, because they
want to charge you five grand. Yeah, you know when
they go on Medicare they can charge you like eight hundred,
so please don't do that. And they find a poll up.
(19:54):
You're paying a lot of money, right, so just wait
to Medicare. Worst case you pay two hundred and fifty
seven dollars. Like, okay, thank you. I had one of
those clients called me back and go it was a
poll up. I said, if you had it on your
last policy, you'd paid five grand. You had paid two
hundred fifty seven dollars because you waited a month and
you listened to me.
Speaker 1 (20:09):
It's like, thank god.
Speaker 2 (20:11):
So again, just really really think about It's why it's
so important to think about it any other thing. With
the pardy you got with the Plan G and the
Medicare supplement, you don't have referrals, don't you can go
anywhere you want. You want to walk into a new
cardiologist to mark go right ahead. You don't need a
prior authorization or anything like that. That's why it's so
so much easier to go that route. But again, it's
(20:32):
worth the conversation to see which option makes sense for
you and your family basic upon the cost and the coverage.
Speaker 1 (20:37):
Well, like the analogy that you wrote down here.
Speaker 2 (20:40):
Yeah, I got another one that's really good too, But
this is the one I like to use because it's
a little bit more easy. But advantage plan is like
leasing a car. Right, there's restrictions, Right, what happens if
your income goes down?
Speaker 1 (20:51):
Can you release it now? Limited number of miles, living
number of miles?
Speaker 2 (20:56):
That's right, And if your finances change, you might not
be able to get into that same car again.
Speaker 1 (21:00):
Right.
Speaker 2 (21:01):
A supplement is like owning it. You have more control. Right,
If I want to go run it up sixty thousand
miles this year, I can do. That doesn't make doesn't
make a difference at that point. So, uh, the best way.
The other way I've already looked at it too, is
like imagine you're going out to you want to you
want a steak. You woke up on a Friday, You're like, hey, honey,
I'm gonna go get a steak tonight. Let's look at
let's go to stak dinner. Like literally, a supplement is
(21:22):
like going to a high end steak restaurant, thinking about
like Jeff Rube's sobs, like one of my favorite places
to go to, right, high end stake place. But when
we go to a high end stake place, what do
you gotta do if you want something else? If I
want the salad, everything's a la car, Right, I gotta
buy everything else. Right, But it's a really good steak, right,
And I would say a medicare advantage plans like Golden growl.
Speaker 1 (21:45):
Yeah they got steak.
Speaker 2 (21:46):
Yeah, you can go whatever else you want.
Speaker 1 (21:47):
You gonna walk out of it like it was a steak. Yeah,
sort of jockey was hitting it. That's right, it's sort
of a stake.
Speaker 2 (21:56):
That's that's the best in knowledge I'm gonna have. Right, Yes,
it's a lot less expensive. Yes, we're going to walk
away and be a little less satisfied at the end
of the day. So again, that's that's another really good
analogy to think about. All right, again, you know what
they don't tell you about Medicare. I'm really hitting on
this because it's so important. Advantage plans can deny claims
via pre authorization. Right, you know their goal, right, because
(22:20):
you've got Medicare out of the realm. Medicare is no
longer the payer, so now it's the insurance company. So
they can turn around and go, hey, we don't want
to do that knee surgery. We're going to make you
go through therapy and get a corda zone shot.
Speaker 1 (22:31):
Right.
Speaker 2 (22:31):
They can push the ball out to try to not
pay fifty sixty grand for your knee replacement. So that's
one of the thing Medicare advantage plans that can do. Also,
you may not be able to switch to a supplemental
plan later due to underwriting. Right, So you have that
initial open enrollment that's seven month period you can get
in a Medicare supplement, no questions asked.
Speaker 1 (22:51):
I mean, you could literally be.
Speaker 2 (22:53):
One foot in the grave and I can put you
in a Medicare supplement at sixty five if you decide, hey,
I'm going to do that zero premium option Medicare advantage plan.
I keep seeing on TV and I buy that plan,
and a year or two later you start realizing you
don't like that plan, and then you come back to me, go, John,
I didn't like that plan. It cost me me too much,
(23:14):
a lot more than I thought. Well, now I have
to write you and go through underwritting, so they're gonna
look at your medical history at that point, and if
you have medical issues. I'm not saying small things, right,
but if you had a heart attack, if you're going
through cancer, if you need a knee replacement, I can't
move you to a supplement. You're stuck on that Medicare
advantage plan usually for at least two to five years,
depending upon the carricer. So again something to really think about.
(23:35):
You can always go to an advantage plan. So if
you start out on a supplement, like I'm traveling doing
all this type of stuff. Now you're eighty five years
old and you don't leave fifty miles from your house,
maybe a Medicare advantage plan is great because you're not
going anywhere. Yeah, so look at those options. This is
why we sit there and analyze it and work with you.
As time goes on.
Speaker 1 (23:51):
You'll still face the challenge if your hospital or your
doctor just walks out on the walk side of the plane.
Speaker 2 (23:57):
Again, there's Medicare advantage PPOs, So that's where we put
everybody on the Medicare advantage side. So you can still
do a pp I just pay a little bit more
if you're at a network, but better than losing your doctor, yeah,
are losing your hospital again. On Medicare, there is no
dental vision or long term care and standard Medicare, so
if you do a supplement, you've got to add those
things on, right, So it's really important that you do that.
(24:18):
Long term care is so important to have that kind
of that conversation. We help a lot of clients get
long term care when I do these reviews of them
and just looking at some of the alternative plans, like
our home health care plan that we do, but yain
it's a la carte. The Medicare advantage plans will sell
you on getting those dental and envision and hearing and
all that type of stuff. They're gonna add a lot
of things to it. They're gonna wow you with Hey,
(24:39):
you can get a over the counter card every quarter
for We'll give you one hundred fifty bucks every quarter
you can use for over the counter medications.
Speaker 1 (24:45):
People like, oh, that's.
Speaker 2 (24:46):
Great, I'm getting all this stuff for free, Like add
it on, you know, this is option. This is great,
But again, look at the trade offs, right, again, there's
no free lunch, so really kind of think about that.
So the myth of it being free can lead to
huge financial shock, right, right, huge financial shock, Like that's
why it's so important.
Speaker 1 (25:04):
And you know, I'll be.
Speaker 2 (25:06):
A little caveat Every year I get people that want
to need to hire them, and they're usually guys that
are getting kicked off medicare advantage companies. Because what happens
that they'll do a big hiring. They're huge call rooms
all over the United States. They hire all these people
and then they're laying everybody off in February, once the
medicare will open like Christmas.
Speaker 1 (25:26):
Christmas.
Speaker 2 (25:27):
Yeah, so again you're not even dealing with an agent anymore.
Like you're literally dealing with some company that's going to
resell your policies to somebody else. Right, So we get
these people all the time, and and the problem is
when I when I talk to them like, Okay, you
can come work for me, but this is my requirements.
Tell me what your understanding is on the supplements and
other things they do. Do they can't even tell.
Speaker 1 (25:44):
Me deer in the headlights. They're deer in headlights.
Speaker 2 (25:46):
So the only thing most of these people know is
Medicare advantage plans, So all they know is how to
sell zero and I'm like, I can't. I can work
with you, like you know you can't. You have to
be able to give your clients options. And you know
we're not pushing zero premium plans. That doesn't make sense
of your client. So again, just very understanding of what's
out there and what what what what we're running against,
(26:06):
just like you.
Speaker 1 (26:07):
Well, it's important. Then you have a conversation with John
and the team. This is you know, don't miss your
Medicare enrollment when to know the risks of Medicare advantage
plan for long term for your personal health situation, and
talk to somebody that knows all the ins and outs
of all this stuff, like John and the team I'd cover.
Speaker 2 (26:26):
I'm gonna leave you with one last penalty that less
it's stilling o great. One last penalty if you do
not sign up for a prescription plan. So we're talking
about the PARTD plan. It is a one percent penalty
per month that adds on for the rest of your
life on top of the Part B ten percent of
year penalty. The Part D prescription plan is one percent
a month. So I get a lot of people to go, Hey, John,
I'm not even on a prescription. I don't want to
(26:46):
do it right now. Why the cheapest plan that makes
the most sense because you can always change that plan.
But if you if you wait five or six years,
you're gonna get hit with sixty percent higher premium on
that plan. And if you need one hundred dollars plus plan,
you're talking that's a lot of money that you're paying
extra per month with a sixty percent surcharge that doesn't
go away, and it last you the rest of your life.
(27:06):
There's nothing I can do to get rid of it.
So again, it's why and so important to have this conversation.
It's why it's so important to get in front of
my team so that we can talk to you, avoid
those penalties, and set you up the right way and
be there long term for you. We're not going anywhere,
so in five years we need to adjust something, or
ten years down the road, we're still here, we're still
working with you, and every year we can make an adjustment.
Speaker 1 (27:26):
If we need to give John on the team a call,
it covers since he no cost or obligation to you
to get this wonderful advice. Tailored to your specific needs.
It's five one three eight hundred two two five five.
That's five one three eight hundred call. You can initiate
the conversation filling out a form online at Covertsinc dot com.
Think about your own best interest and get in touch
with John and the team. Again, no cost or obligation
(27:47):
to you. John, it's always a pleasure talking to me.
Thanks so much for all that you have done for
the listeners of this program, and the listeners who've taken
me up and heeded my suggestion. They give you a ring.
I've helped out a lot of folks out.
Speaker 2 (27:59):
Absolutely one of the things guys that we'll do too.
We actually have some social media accounts. We have an
Instagram account cover Sincy that you guys can follow. We
do put a lot of really good resources on the
medicare side on there. So I know this is only
a thirty minute segment, but we do a lot of
breakdowns on different things on there and how to utilize coverages.
We talk about long term care, some really good scenarios
(28:19):
that you can go through, just really more educational. That's
why I did my social media side. It's not just marketing,
it's I want you to be able to go there
to see things, to kind of get a better understanding
on an unbiased view, and you're not just googling Medicare
and then filling out your information getting from everybody else too,
so good information there for you.
Speaker 1 (28:36):
This has been another edition of Rethink Healthcare together with
John Roman from Cover Sincy
Hi. Tryan Thomas normally hosts of the fifty five Casey Morning
Show from five to nine am Monday through Friday. But
I get the opportunity and I enjoy my conversation with
John Rohlman of Cover since every Sunday at this time
we rethink healthcare together, and I'm glad you're able to
tune in. Got some important things to talk about today. Notably,
we're going to focus on medicare. We've talked about this
topic before, but John and his team are medical insurance specialists.
(00:27):
Always like to emphasize they're working for you with access
to hundreds of insurance companies and thousands of different policies,
but he's always thinking about your best interest and looking
at where you are in life. Last week we talked
about the different stages of life and how important it
is to take a look at your coverage. You know,
if you're just newly married, the kids coming along, kids
are teenagers, you're getting ready to retire, and so moving
(00:48):
to that latter category, you're getting ready to retire. Medicare
certainly is a part of the discussion, and John's got
a lot of important information to passing along to you
on the subject. Of medicare, John, it's always place as
you're talking with you on a Sunday morning. Oh you too, Brian.
So we've been down this road before, and I know
your phone starts ringing off the hook every time you
and I bring up this topic. But it's so important
(01:12):
to do it, right. I mean, you just get to
that age. I'm on medicare now, but there's a lot
of layers and complexities and components that go along with that,
and a lot of things that people need to think
about in advance. Oh. Absolutely.
Speaker 2 (01:23):
I mean Medicare for most people, Brian, is just completely foreign, right,
because most people have had their health insurance taken care
for them, right, They've been an employer, right, they just
like pick option one, two or three, Okay, this is
the one I want. That's it, right, So they don't
really understand in a lot of cases how insurance works.
And number two that they have a lot of options
(01:43):
and it really confuses them. And I've seen the Medicare
and You book that these guys get. It is like
eighty pages and they just literally use it as a
weight on their coffee table. They can't get through it.
They don't understand it. It's just it's written I think
to be confusing. And you know it's funny because when
they call in to talk to me my representatives, that
(02:04):
basically endser the phone. I've had to train them how
to walk clients through to make sure they're set up
so when I meet with them, I can help them.
And that's I mean, so many people call in they're like, hey,
I'm I'm a Medicare. I just got it last month,
and you know, I need to talk to John about
what else I need to do. And then we find
out they're not even set up yet, like they didn't
get their part b you know, they don't even have
(02:24):
their documentation set in right. I mean, there's so many people.
I would say probably three and every five people that
call in aren't set up the right way, really yeah,
or don't know what they need to do, and so
we're really doing a lot of education. Before I didn't
even talk to me to make sure they got every
other ducks in a row. But really, it's kind of
the purpose of the show today is you've listen. If
(02:46):
you listening to this, or you're a year out or
currently like ready to get on Medicare or already on it,
you know and like, oh, I didn't realize I didn't
have that. You know, the goal here today is you know,
talking about making sure you can pick the right plan,
you know, and avoiding penalties.
Speaker 1 (03:00):
That's all that word. I was getting ready to bring
that up. So folks stick around because there's some pitfalls. Yeah,
they involve penalties.
Speaker 2 (03:07):
And of course protecting your future health and fitness and
finances right you know. So it's like that just makes
more sense to because so many people don't realize like
oh I got A and B and I'm good, and
then they realize they are all kinds of holes and or
they're in a long term care situation and running out
of money, or you know, now they're tapping into all
their reserves and nested because they didn't do the right thing.
(03:28):
So this is why it's so important to really listen
to day. So again, you know, this is for people
that are already on medicare, you know, if you're turning
sixty five, or maybe you're an adult child just kind
of helping your parent kind of go through that situation.
This is really, you know, the nice thing about it
because again, medicare is not free. You know, it's not
(03:48):
simple and getting it wrong can be extremely costly. Right,
So again let's kind of get in through the the
what I call the four parts of medicare and the
basics you really need to know. So again, Part A
is what you get at sixty five. Now again you
have to make sure you enroll into these type of
things because you got to get documentation and notices. You know,
(04:12):
Center for Medicare Services has to be updated on like
your physical address where you actually live. Well, I got
two addresses. I have a part time place that I
live in Florida. Like you need to make sure your
place here in Ohio where you're at as your primary,
you know, and make sure that's all set up the
right way. And usually Part A is free all right,
so long as you work ten years. And they talk
about like the forty credit quarters or whatever that you
(04:34):
have to go through. We just had a client the
other day. They the spouse, the wife she's never worked,
her husband's always worked, paid into medicare, and I guess
he ended up passing away. And so she went to
go apply for her medicare and they basically told her
she didn't have enough time worked. And I was like,
she wor and she didn't, but but she did because
(04:56):
her husband didn't. Oh so when you're married, the husband
paying in sat ASFI as your Medicare. So I got
so guess who had it wrong? Medicare? So she was ready, Yeah,
really had it wrong. So we had to help her
walk through that scenario so that she could get her
Medicare for part eight for free. I was one of
the things we had to do because she was so
confused thinking that they I think they sent her a
(05:17):
bill for like six hundred and eight hundred bucks or
something like that.
Speaker 1 (05:19):
A month.
Speaker 2 (05:20):
She said, I can't afford this. I was like, you
do you don't. I don't think you have to pay this.
Let's let's walk you through your head to do this.
We really help her. So again, typically parties free, but
there are scenarios and we can help you get through
that if if they're telling you something differently. Part B
all right is your outpatient cover. So basically, anything you
do outside of the hospital all right is your Part B.
You have to elect to get into this all right,
(05:43):
and it's extremely important that you do that because there
there's penalties if you don't do it all right. But
Part B is your outpatient cover. So anything outside of
the hospital. If you don't take Part B, anything outside
of going into the hospital, you will be paying one
hundred percent on which is going to be about eighty
percent of your potential claims.
Speaker 1 (05:59):
So careful, but going to see your cardiologists, going.
Speaker 2 (06:02):
To see your cardiologist, or having an outpage and procedure,
you know, having a diagnostic like NMRI. So like listen,
all stuff you're doing outside of the hospital. These are
outpatient charges. Be very careful here. But there is a
premium to this, Okay. I don't care which plan you're on.
If you take an advantage plan, if you do anything else,
you're paying for Part B premium and again depending upon
your situation. That's why it's so important to talk to us,
(06:25):
you know, by planning your finances before you turn sixty
five and make sure you're a good spot. The government
loves to charge us more money if we make more money,
so there could be I've seen people pay five six
hundred dollars a month more for Part B because they
didn't get their their their their stuff situated the right
way and decide to sell a big old property right
before and pay all kinds of taxes on it and
then another another get stuck in an IRMA situation. So again, listen,
(06:49):
you can look it up if you have to. If
you're a husband and wife and you're making typically less,
I think it's like two hundred and five two hundred
and fifteen thousand dollars a year. This doesn't come into
your realm, but it is a good conversation to have.
You know, if you're at that level, there's ways that
I can help you get that down. I know how
to work with the government and get these things taken
care of. So that's why it is so important to
(07:09):
kind of work with someone that is in that realm,
because Medicare can be very costly if you're doing it
the wrong way. Part D, so again, Part b's optional
but highly recommend it. Part D is also optional but important.
Part D is your prescription drug coverage. Okay, it is
very important that you pick up a prescription drug plan
because without it, you can only enroll in this once
(07:31):
a year. You can't be like, well, it's July, I'm
not on a prescription but if I start one next month,
I can get on. It doesn't work that way. You
can only do it during the open rollment each year.
So you be very careful. There's also a penalty if
you don't take it out. And then Part C, which
is kind of in between the B and D. You know,
that's where you go with a private insurance company and
there's a couple options. We'll get into that as far
as what you're going to do to that. But again
(07:52):
remember Medicare doesn't cover everything. Medicare doesn't cover dental, they
don't cover vision, they don't cover hearing, and guess I'll say,
don't cover Brian.
Speaker 1 (08:00):
Long term care term care.
Speaker 2 (08:01):
Right, so if you are at a facility or needing
a nurse to come take care of you at your house,
Medicare doesn't pay for that, all right, So again think
about Medicare is basic coverage. It is not full protection.
I always say, anything the government's gonna give you is
gonna have holes. And there's some big ones when it
comes to Medicare, And so making sure you do it
the right way and sit down with something like really
(08:22):
an expert in that field and can give you all
the options so that you can make a good decision.
That's so important this point, and really get you through
all the fluff, right, there's so much fluff out there.
I love Medicare season because I get to see all
my ex favorite football players come on TV and talk
about the companies that they're you know, sponsoring and invested in.
(08:44):
You know, it's like, oh, look, that guy's seventy years old.
Then I remember when he used to play football, So
my dad would tell me that. And you know, those
are the guys kind of pushing plans. You know, if
they're pushing plans, typically I'll tell you it might not
be the one you really want.
Speaker 1 (08:58):
They get paid, I'm sure it probably ansombly to push.
Speaker 2 (09:00):
Most of them are investors in those companies.
Speaker 1 (09:02):
Oh great. So three most.
Speaker 2 (09:05):
Common and costly medicare mistakes right number one missing your
enrollment period. Guys, this is so important. You have a
long time to do it. So you have three months
before your sixty fifth birthday, the month of your sixty
fifth birthday, and three months after to get this all
taken care of. So you have like a seven month window. Okay,
(09:26):
so there's plenty of time to get things done. Don't
fret last minute. I can help you in any realm.
But this is so important to like start having that
conversation three or four months before your sixty fifth birthday,
so that we get it all taken care of the
right way. And even if you've got number one, even
if you've got Medicare early. I got a lot of
people that are on disability, like in their fifties, they're
on Medicare disability for whatever reason. Re look at it
(09:46):
at sixty five because there's more options. You don't have
a lot of options when it comes to under sixty
five for Medicare of supplements and Medicare advantage plans. You
get all the options when you turn sixty five. I've
help so many people get way better covered so they
couldn't get when they're on medica your disability. They turned
sixty five, they got lights out coverage like because they
were able to get more options. So again, relooking at
(10:06):
that at your sixty to birthday is so important.
Speaker 1 (10:08):
Right, Let's give people the bad news.
Speaker 2 (10:09):
Yeah, the bad news here Medicare Part B penalty. So
every year you don't take a Medicare Part B it
is a ten percent penalty each and every year that
lasts you the rest of your life.
Speaker 1 (10:23):
You can't unring that bell, can't ring it. There's not
something I can do.
Speaker 2 (10:26):
So if you didn't pick up your Part B and
you just turned seventy years old, you're five years in.
You're paying fifty percent more for that for the rest
of your life, and this year it's one hundred and
eighty five bucks, so you know you're paying that plus
fifty percent, So another ninety dollars a month added to
that for the rest of your life for the same thing.
(10:46):
Everybody else is getting it for fifty percent cheaper. So
making sure you do it now. If you have credible coverage,
you're still working through an employer, and it's considered credible,
you don't have to opt to Part B. So many
people buy Part B and they're still working and they
have group health benefits. Guys, you don't have to buy it.
Don't pay the extra money. It's really not going to
do much for you, so you don't have to buy it.
If you have any questions, that give us a call.
(11:07):
You can see if that makes sense for you.
Speaker 1 (11:08):
To have incredible coverage during that So if you're still working,
then you're not going to be subject to the ten
percent penalty when you roll later.
Speaker 2 (11:15):
Correct okay, correct, correct if it's credible, we'll get to
that in a minute, all right, So again, staying on
your employer coverage too long, especially risky at small companies
less than twenty employees, just because a lot of these
companies might not have credible coverage. So one of the
biggest things we saw this last year was that credible
coverage has to be where you don't have an out
(11:36):
of pocket expense for prescriptions more than two grand. Most
people's health insurance plan out of pocket is more than
two grand. Oh really yep, So one of the rule
changes for last year, and they extended it into this
year because they didn't want to do the penalty right away.
But this year, we don't know if they're going to
remove that, and I'm not hearing that they are. So
what basically that means is if you're on an employer
group plan and your prescription out of pocket is more
(11:58):
than two grand on your plan, it's not considered credible
and then you're going to be subjucated to those penalties.
And you'll typically see this on groups less than twenty
employees because the coverage is usually aren't very good there.
So again something to really think about. If you're like
sixty six, sixty seven years old, like, well, I'm gonna
probably keep working. You do not want to be coming off,
and then we have to turn around and tell you,
I'm sorry your plan was not considered credible through your group.
(12:19):
Even though you were working there and get paying for
group benefits, you're still subjucated to the penalty. So it
is a really good conversation to have because I don't
want to see you coming in and tell you sorry, ma'am,
you got to pay forty percent more. You know, so
really really important choosing a Medicare advantage plan without understanding it. Listen,
I see these people, we sell them. I'm literally doing
(12:40):
this certification to do Medicare advantage plans right now. We
help so many listeners in the area last year that
I am training my.
Speaker 1 (12:47):
Entire office how to do it.
Speaker 2 (12:49):
I would just me and one other my agents last
year because we didn't realize how many people needed help.
We had so many people call in, so many people
that we help. I'm training my entire salesforce this year
on Medicare advantage and most of it is to help
these individuals change their plans from plans other people had
them set up on that was not perfect for them.
So we had to make a lot of changes a
(13:09):
lot of people are on HMOs, and I highly suggest
you don't be on one. You look down at your
insurance card right now, open up your wallet. Look at
your insurance card. If it says XYZ insurance company and
it says HMO, please schedule an appointment with me in
September for October so we can really look at it.
You probably need a PPO. We saw so many doctor
networks leave last year in the middle of the year
(13:30):
that's moved HMLO right away. HMO is going to be
the most restrictive, and listen, you probably shouldn't be there.
And I always say I don't want to put my
worst enemy in HMO, so I'm probably going to recommend
something else. I'm going to show you an alternative so
that you don't lose your cardiologists or your primary care
in the middle of the year because they decided to
be in a contract to speak with the insurance company
(13:51):
and no longer in there. We saw the Lender Center
leave major insurance company last year, saw Christ's Hospital. I mean,
I see huge Saint Eves. I've seen happen even the
middle of Medicare advantage open enrollment, Like you need to
be protected guys, you can't make a change till the
end of the year. Don't be without the people that
you need for an entire year because you took the
(14:11):
wrong plan. So again, low premiums right, that they sell
you on the zero premium options, and the low premiums
doesn't mean it's good coverage.
Speaker 1 (14:21):
Right.
Speaker 2 (14:21):
Many of these plans have huge out of pocket expenses
and you know, can be over eight grand, you know,
if you're doing the wrong thing. So there's I always say,
there's no free lunch. There's a catch, and we want
to talk about those catches and see if they make.
Speaker 1 (14:33):
The most sense for you.
Speaker 2 (14:35):
So again, Medicare advantage.
Speaker 1 (14:36):
You know.
Speaker 2 (14:37):
The nice thing about it, it does combine your AB
and D, but you're also losing your original Medicare. And
what does original medicare give you, Brian, access to every
doctor in hospital the United States? It takes Medicare, right.
I always talk about places like M d Anderson because
I know if any of my family members have got cancer,
I'm running down there. It's one of the best cancer
hospitals in the world. I want the best treatment in
(14:59):
those situations, you know. And if I haven't metcare advantage plan,
I can't go there, you know, so something something to
really think about. Right, it's you know, but it does
combine everything. So what happens to the Medicare advantage plan.
You're basically giving up your original Medicare and everything's flowing
through to an insurance company. Right, So they're going to
be able to start making those decisions. They're gonna say, hey, referral,
(15:22):
referral prior off, prior off, right, I mean they're gonna
start going, oh, you can't go there, or like I
just said, oh, we're not, we don't take that doctor anymore.
So it puts you into a really it can put
you into a really bad situation, you know, if you're
not doing the right thing, and the out of pocket
expenses on these plans are getting higher. I was doing
one of the states in the northeast, I think it
(15:43):
was a New Jersey where I'm from originally, and I
was looking at some of the out of pockets in there.
It was like ten grande. I was like wow, I
was like, these are really really high. Obamacare ninety two hundred,
they're going up a ten grand this year for twenty
twenty six. So yeah, I mean it's a but again,
just kind of really understand that situation, and especially if
(16:04):
you're turning sixty five and have some medical issues, Medicare
advantages doesn't mean it's the best option for you. I
mean really, sometimes it's better off to pay and get
yourself a meta gap plan, which is next thing we'll
talk about. Because you're out of pocket, expenses are far less,
so medi gap or Medicare supplement. This is what my
parents are on, and for most of my clients, you know,
this is where they ended up going. I would say
(16:24):
Medicare advantage is probably about twenty five percent of the
actual business that we do through our office. About seventy
five percent of our clients are on Meta gap or
Medicare supplement plans. But it works alongside your Medicare A
and B, So basically it's a supplement. Just how we
sell coverage for the under sixty five market. We add
this to your plan and it gets rid of all
those holes, right, and you have nationwide access. That's what's huge.
(16:47):
I mean, go anywhere you want you travel. Hey, you
plan on retraveling at retirement at sixty five, do you
want to just stay in the greater Cincinnati area or
do you want to go to Florida or maybe take
a trip in the Caribbean or wherever it is. Care
something that's going to do a lot better for you
because you can go anywhere you want with no restrictions as.
Speaker 1 (17:04):
Long as the doctor takes Medicare, as long.
Speaker 2 (17:05):
As they Medicare. I haven't run to one hasn't okayough,
But I mean yeah, I mean you're talking about like
nine to nine point nine percent of the doctors and
hospitals that are out there you can go to. Again,
predictable costs, little higher premiums. We're are seeing a little
bit of a tick up in this realm. You know,
if you're listening this right now, all that this this
is me. I'm going a Medicare supplement. Look at your
(17:26):
pricing right now.
Speaker 1 (17:28):
COVID.
Speaker 2 (17:29):
We just saw the COVID pricing here hit last quarter.
So everything that happened during COVID, all the insurance companies
finally did their Actu Royal science and started raising rates.
If you've seen a significant rating increase, I'm talking about
anything over twenty bucks, give us a call. I have
like forty different medicare supplement companies I work with. I
have the cheapest options, and a lot of times you're
(17:49):
fairly healthy, I can just switch you to the same
plan you're with because it's exactly the same coverage and
save you money. We just talked to a client. We
saved there eighty bucks a month, oh by moving her
to the exact same coverage a different carrier one thousand
bucks a year, Brian, same as that coverage, no difference,
it is you know, so again you can re look
at this and reashop them.
Speaker 1 (18:08):
Right.
Speaker 2 (18:08):
It's it is predictable as far as costs. Right, if
you're turning sixty five right now, I tell people, don't
really overthink the coverage. Look at Option G. So with
Medicare supplements, you have a through N letters right and
are your plan options? Plan G is the best plan.
Plan G covers all those out of pocket expenses that
Medicare has, thills, all those holes except one the part
(18:31):
be deductible and this year's deductibles two hundred and fifty
seven dollars. So imagining getting on Medicare and knowing the
most I can pay going to a doctor or having
an MRI or anything that I do with two hundred
and fifty seven bucks a year, it is the best coverage.
Speaker 1 (18:46):
You'll ever have. Yeah, I've heard you say that.
Speaker 2 (18:47):
You can literally go in the hospital pay nothing if
I set you up like this. So Plan G is
the best option out there. It's really affordable in our
area right now. And especially you have some medical issues.
You're guaranteed issue TEED acceptance right now. When you turn
sixty five, they can't look at your medical history. So
we have so many people to call in and they're like, hey, yeah,
I got all this kind of going on. I need
to have a knee replacement surgery. I say, don't overthink it.
(19:10):
I'm putting in a Medicare supplement and you're to pay
two hundred fifty seven dollars to the new NIE and
nothing for the therapy after that. So yeah, I mean,
this is this is a great situation. Uh, just I
just want to hit on this. From whatever I'm seeing
is doctors love to recommend people start getting testing done
right before they go on Medicare. Please push that off.
Do not be going in getting a colonoscould be two
(19:32):
months before you go on Medicare. I mean it's a
money grab, absolutely. I've told five of my clients in
the last year they called me and told me, my
doctor just recommend I get at Colonoscarby. I'm like, okay,
and like two months you go back. No, he wants
me to do it next month. I'm like, because they
want to charge you five grand. Yeah, you know when
they go on Medicare they can charge you like eight hundred,
so please don't do that. And they find a poll up.
(19:54):
You're paying a lot of money, right, so just wait
to Medicare. Worst case you pay two hundred and fifty
seven dollars. Like, okay, thank you. I had one of
those clients called me back and go it was a
poll up. I said, if you had it on your
last policy, you'd paid five grand. You had paid two
hundred fifty seven dollars because you waited a month and
you listened to me.
Speaker 1 (20:09):
It's like, thank god.
Speaker 2 (20:11):
So again, just really really think about It's why it's
so important to think about it any other thing. With
the pardy you got with the Plan G and the
Medicare supplement, you don't have referrals, don't you can go
anywhere you want. You want to walk into a new
cardiologist to mark go right ahead. You don't need a
prior authorization or anything like that. That's why it's so
so much easier to go that route. But again, it's
(20:32):
worth the conversation to see which option makes sense for
you and your family basic upon the cost and the coverage.
Speaker 1 (20:37):
Well, like the analogy that you wrote down here.
Speaker 2 (20:40):
Yeah, I got another one that's really good too, But
this is the one I like to use because it's
a little bit more easy. But advantage plan is like
leasing a car. Right, there's restrictions, Right, what happens if
your income goes down?
Speaker 1 (20:51):
Can you release it now? Limited number of miles, living
number of miles?
Speaker 2 (20:56):
That's right, And if your finances change, you might not
be able to get into that same car again.
Speaker 1 (21:00):
Right.
Speaker 2 (21:01):
A supplement is like owning it. You have more control. Right,
If I want to go run it up sixty thousand
miles this year, I can do. That doesn't make doesn't
make a difference at that point. So, uh, the best way.
The other way I've already looked at it too, is
like imagine you're going out to you want to you
want a steak. You woke up on a Friday, You're like, hey, honey,
I'm gonna go get a steak tonight. Let's look at
let's go to stak dinner. Like literally, a supplement is
(21:22):
like going to a high end steak restaurant, thinking about
like Jeff Rube's sobs, like one of my favorite places
to go to, right, high end stake place. But when
we go to a high end stake place, what do
you gotta do if you want something else? If I
want the salad, everything's a la car, Right, I gotta
buy everything else. Right, But it's a really good steak, right,
And I would say a medicare advantage plans like Golden growl.
Speaker 1 (21:45):
Yeah they got steak.
Speaker 2 (21:46):
Yeah, you can go whatever else you want.
Speaker 1 (21:47):
You gonna walk out of it like it was a steak. Yeah,
sort of jockey was hitting it. That's right, it's sort
of a stake.
Speaker 2 (21:56):
That's that's the best in knowledge I'm gonna have. Right, Yes,
it's a lot less expensive. Yes, we're going to walk
away and be a little less satisfied at the end
of the day. So again, that's that's another really good
analogy to think about. All right, again, you know what
they don't tell you about Medicare. I'm really hitting on
this because it's so important. Advantage plans can deny claims
via pre authorization. Right, you know their goal, right, because
(22:20):
you've got Medicare out of the realm. Medicare is no
longer the payer, so now it's the insurance company. So
they can turn around and go, hey, we don't want
to do that knee surgery. We're going to make you
go through therapy and get a corda zone shot.
Speaker 1 (22:31):
Right.
Speaker 2 (22:31):
They can push the ball out to try to not
pay fifty sixty grand for your knee replacement. So that's
one of the thing Medicare advantage plans that can do. Also,
you may not be able to switch to a supplemental
plan later due to underwriting. Right, So you have that
initial open enrollment that's seven month period you can get
in a Medicare supplement, no questions asked.
Speaker 1 (22:51):
I mean, you could literally be.
Speaker 2 (22:53):
One foot in the grave and I can put you
in a Medicare supplement at sixty five if you decide, hey,
I'm going to do that zero premium option Medicare advantage plan.
I keep seeing on TV and I buy that plan,
and a year or two later you start realizing you
don't like that plan, and then you come back to me, go, John,
I didn't like that plan. It cost me me too much,
(23:14):
a lot more than I thought. Well, now I have
to write you and go through underwritting, so they're gonna
look at your medical history at that point, and if
you have medical issues. I'm not saying small things, right,
but if you had a heart attack, if you're going
through cancer, if you need a knee replacement, I can't
move you to a supplement. You're stuck on that Medicare
advantage plan usually for at least two to five years,
depending upon the carricer. So again something to really think about.
(23:35):
You can always go to an advantage plan. So if
you start out on a supplement, like I'm traveling doing
all this type of stuff. Now you're eighty five years
old and you don't leave fifty miles from your house,
maybe a Medicare advantage plan is great because you're not
going anywhere. Yeah, so look at those options. This is
why we sit there and analyze it and work with you.
As time goes on.
Speaker 1 (23:51):
You'll still face the challenge if your hospital or your
doctor just walks out on the walk side of the plane.
Speaker 2 (23:57):
Again, there's Medicare advantage PPOs, So that's where we put
everybody on the Medicare advantage side. So you can still
do a pp I just pay a little bit more
if you're at a network, but better than losing your doctor, yeah,
are losing your hospital again. On Medicare, there is no
dental vision or long term care and standard Medicare, so
if you do a supplement, you've got to add those
things on, right, So it's really important that you do that.
(24:18):
Long term care is so important to have that kind
of that conversation. We help a lot of clients get
long term care when I do these reviews of them
and just looking at some of the alternative plans, like
our home health care plan that we do, but yain
it's a la carte. The Medicare advantage plans will sell
you on getting those dental and envision and hearing and
all that type of stuff. They're gonna add a lot
of things to it. They're gonna wow you with Hey,
(24:39):
you can get a over the counter card every quarter
for We'll give you one hundred fifty bucks every quarter
you can use for over the counter medications.
Speaker 1 (24:45):
People like, oh, that's.
Speaker 2 (24:46):
Great, I'm getting all this stuff for free, Like add
it on, you know, this is option. This is great,
But again, look at the trade offs, right, again, there's
no free lunch, so really kind of think about that.
So the myth of it being free can lead to
huge financial shock, right, right, huge financial shock, Like that's
why it's so important.
Speaker 1 (25:04):
And you know, I'll be.
Speaker 2 (25:06):
A little caveat Every year I get people that want
to need to hire them, and they're usually guys that
are getting kicked off medicare advantage companies. Because what happens
that they'll do a big hiring. They're huge call rooms
all over the United States. They hire all these people
and then they're laying everybody off in February, once the
medicare will open like Christmas.
Speaker 1 (25:26):
Christmas.
Speaker 2 (25:27):
Yeah, so again you're not even dealing with an agent anymore.
Like you're literally dealing with some company that's going to
resell your policies to somebody else. Right, So we get
these people all the time, and and the problem is
when I when I talk to them like, Okay, you
can come work for me, but this is my requirements.
Tell me what your understanding is on the supplements and
other things they do. Do they can't even tell.
Speaker 1 (25:44):
Me deer in the headlights. They're deer in headlights.
Speaker 2 (25:46):
So the only thing most of these people know is
Medicare advantage plans, So all they know is how to
sell zero and I'm like, I can't. I can work
with you, like you know you can't. You have to
be able to give your clients options. And you know
we're not pushing zero premium plans. That doesn't make sense
of your client. So again, just very understanding of what's
out there and what what what what we're running against,
(26:06):
just like you.
Speaker 1 (26:07):
Well, it's important. Then you have a conversation with John
and the team. This is you know, don't miss your
Medicare enrollment when to know the risks of Medicare advantage
plan for long term for your personal health situation, and
talk to somebody that knows all the ins and outs
of all this stuff, like John and the team I'd cover.
Speaker 2 (26:26):
I'm gonna leave you with one last penalty that less
it's stilling o great. One last penalty if you do
not sign up for a prescription plan. So we're talking
about the PARTD plan. It is a one percent penalty
per month that adds on for the rest of your
life on top of the Part B ten percent of
year penalty. The Part D prescription plan is one percent
a month. So I get a lot of people to go, Hey, John,
I'm not even on a prescription. I don't want to
(26:46):
do it right now. Why the cheapest plan that makes
the most sense because you can always change that plan.
But if you if you wait five or six years,
you're gonna get hit with sixty percent higher premium on
that plan. And if you need one hundred dollars plus plan,
you're talking that's a lot of money that you're paying
extra per month with a sixty percent surcharge that doesn't
go away, and it last you the rest of your life.
(27:06):
There's nothing I can do to get rid of it.
So again, it's why and so important to have this conversation.
It's why it's so important to get in front of
my team so that we can talk to you, avoid
those penalties, and set you up the right way and
be there long term for you. We're not going anywhere,
so in five years we need to adjust something, or
ten years down the road, we're still here, we're still
working with you, and every year we can make an adjustment.
Speaker 1 (27:26):
If we need to give John on the team a call,
it covers since he no cost or obligation to you
to get this wonderful advice. Tailored to your specific needs.
It's five one three eight hundred two two five five.
That's five one three eight hundred call. You can initiate
the conversation filling out a form online at Covertsinc dot com.
Think about your own best interest and get in touch
with John and the team. Again, no cost or obligation
(27:47):
to you. John, it's always a pleasure talking to me.
Thanks so much for all that you have done for
the listeners of this program, and the listeners who've taken
me up and heeded my suggestion. They give you a ring.
I've helped out a lot of folks out.
Speaker 2 (27:59):
Absolutely one of the things guys that we'll do too.
We actually have some social media accounts. We have an
Instagram account cover Sincy that you guys can follow. We
do put a lot of really good resources on the
medicare side on there. So I know this is only
a thirty minute segment, but we do a lot of
breakdowns on different things on there and how to utilize coverages.
We talk about long term care, some really good scenarios
(28:19):
that you can go through, just really more educational. That's
why I did my social media side. It's not just marketing,
it's I want you to be able to go there
to see things, to kind of get a better understanding
on an unbiased view, and you're not just googling Medicare
and then filling out your information getting from everybody else too,
so good information there for you.
Speaker 1 (28:36):
This has been another edition of Rethink Healthcare together with
John Roman from Cover Sincy
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