October 15, 2025 • 23 mins
Learning about Medicare 2025 San Antonio Medicare Agent San Antonio
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
The topics and opinions express in the following show are
solely those of the hosts and their guests and not
those of W FOURCY Radio. It's employees are affiliates. We
make no recommendations or endorsements for radio show programs, services,
or products mentioned on air or on our web. No
liability explicitor implies shall be extended to W FOURCY Radio
or its employees are affiliates. Any questions or comments should
be directed to those show hosts. Thank you for choosing
(00:21):
W FOURCY Radio.
Speaker 2 (00:26):
Welcome to the Ask the Experts Show on W FOURCY
Radio and Talk for TV, where we bring you educational
information from top local experts in the fields of legal, health,
financial and home improvement. Now sit back and listen to
experts in family law, association, law, hearing laws, business brokers,
(00:47):
home care, along with many other topics. Now Here are
your hosts, Spivo and Sophia.
Speaker 3 (00:55):
Hey, good morning, San Antonio. Welcome to another SC expert show.
For the last sixteen years, we have brought you the
top experts in the field of legal, health, financial and
home improvement. Hey, today is a very special day for Medicare.
We are so lucky we got the top Medicare agents
(01:17):
in San Antonio. Listen to this. What a great name
Medicare gals, the Signature team. Let me welcome you to
Susan Ship. Good morning, Susan, good morning.
Speaker 4 (01:30):
How are you?
Speaker 3 (01:31):
I'm good? Are you ready for today?
Speaker 4 (01:34):
Today's gonna be nuts. Since the day that everyone can
start their enrollment into Medicare, change their plans and all
that fun stuff.
Speaker 3 (01:43):
Well, the reason I am so excited about this show.
First of all, you've been asking us to a show
on Medicare for the last four years. We just haven't
had an opening. But I got to tell you I'm
on Medicare showing my age, and I made so many
mistakes that were costly to me, and I don't want
(02:05):
you to make the same mistakes I make. You know,
for you people who are new to Medicare, this is
the greatest show to be watching or listening and tell
us about your company.
Speaker 4 (02:18):
So we are a team of Medicare insurance experts, and
we are passionate about helping people. Medicare is so confusing
to people, and I know you've been through the confusing part,
and you know we just are there to educate and
lend a helping hand. To those who just are very
confused because you've get so much stuff in the mail
(02:39):
on TV and you're like, what's right, what's wrong? You know,
and you want to hear it from someone who's licensed,
local and trusted, and that's what we do. We are
just a local resource in your community to ask questions,
help with anything that you have going on, any issues,
and help with the enrollment process, and we become your
patient advocate so you don't have to call the insurance company.
(03:01):
You call us because we can usually help navigate quicker
than you getting transferred through the insurance company phone lines.
Speaker 3 (03:10):
Susan, we started promoting your show several days ago and
the questions start pouring in, and tell you what people
are confused about all these national commercials and the robo
calls yes and the things that they promise. A lot
of these questions were some of this stuff sounds too
(03:32):
good to be true. But if I'm correct, in Texas,
it's different by county, isn't it.
Speaker 4 (03:41):
The whole entire country is different by county. So that's
the thing is what you see on TV may not
apply to you based on your zip code and based
on your county. So these are national campaigns. And you
know what they do is they want you to call
that phone number. And so you call that phone number
and they look up your zip code and they're like, oh, sorry,
(04:02):
you don't qualify for that, but let me tell you
what you do qualify. So they just dangle that you know,
shiny little object. Yeah, you fall for it, right, and
then they get you into a plan that's not even
good for you. These are national ads, they are not
local ads.
Speaker 3 (04:19):
Susan. I got to say this because it was a
big problem for me. Folks. It's so important that you
get a good agent. Now. I'm gonna tell you why.
My first agent, Susan was horrible. And what I mean
by horrible is they basically showed me one plan when
(04:40):
they could have showed me six or seven plans. And
then when my first year was up, they didn't even
call me. They just assumed I wanted the same plan.
And I have a good agent here in Florida now.
But I know that customer service is so important.
Speaker 4 (04:59):
Absolutely. That's one thing we pride ourselves with is we
are not just one and done. We're with you throughout
the years. We are constantly in contact with you. You
get newsletters from us. You always know, are in the
know when we find out stuff. You know, we do
client reviews with you face to face or over the
phone or via zoom with you every single year. So
(05:21):
right now I'm in the middle of a lot of
client reviews. So we always are with you. We're not
just you know, sign you up and then see you later.
So we are always always with you. And you call us.
You have our cell phone numbers, you have our direct
numbers that you can call us if you have any issues,
any questions. So you know, that's one thing we do
(05:44):
pride ourselves with.
Speaker 3 (05:46):
Somebody wrote a sin who actually called in with the
question wanting to know about changes, and because of when
the show was last month, you couldn't even divulge any
of those shit. Yeah, what kind of changes are we
looking for now?
Speaker 4 (06:04):
So the Medicare premium is increasing, so we know that
that's every year. That's and then there are changes to
a lot of the plans. There are some insurance carriers
that are pulling out of counties the Austin area, San
Antonio area, Waco area. I mean they're just pulling out
(06:26):
because they're not being profitable, so therefore they are terminating plans,
and if you're on one of those plans, then you
might not be covered for next year. So that's why
it's very important to read your letters, read that annual
notice of change that comes out, and honestly, there are
changes to a lot of like the Medicare advantage plans
(06:46):
and the drug plans, increased premiums, increased copays, reduced benefits.
So there's a lot of changes. You just want to
review because what's good this year may not be good
next year.
Speaker 3 (06:59):
I got to tell you here I I'm on Humana,
and I got to tell you this is the reason
why you should check with your agent. Two years ago,
I got glasses. Did not cost me a dime. They
paid for exam everything I went in two days ago
and it was one hundred and seventy dollars. So in
(07:23):
two years it changed, but it shows that's why it's
so important that you did a good agent, because maybe
the plan that was great for you last year might
not be good for you this year. Yes, so what
are the key date of people she remember for this
year's enrollment?
Speaker 4 (07:41):
So today October fifteenth starts your enrollment process to meet
with agents like me and we can reviewer planned and
it runs through December seventh, so you know, you have
about nine weeks of time to do some enrollment. If
after dec Number seventh you don't make a change, there
(08:03):
is an open enrollment period and those are for people
only on Medicare advantage plans from January through March. That
can make another change. So but the key dates really
are October fifteenth through December seventh.
Speaker 3 (08:18):
I got it something funny and I spoke to my agent.
They said, you know you're going to be getting not
a lot more, but a little bit more each month.
It goes to my Social Security. Yes, but I didn't
know is the rates went up, so it kind of
washed that out.
Speaker 4 (08:37):
It's a moot point. You get your cost of living
increase and then the medicure premium increase, and it kind of.
Speaker 3 (08:43):
Washes what are you just out of curiosity. You've heard
the President talk about Pfizer and there's another company just
came out that are going to be reducing a lot
of their products by as much as eighty percent. Well
that current this year?
Speaker 4 (09:01):
No.
Speaker 3 (09:01):
No.
Speaker 4 (09:02):
So that's the thing is like everything's set in stone
for twenty twenty six. It usually takes about two years
for anything any bill to kind of come to fruition. Now,
the thing is is twenty twenty seven. They will start
negotiating twenty twenty seven in February, so they start early.
(09:24):
So right now, no, nothing has changed with the anything
with President Trump with what he did so, but it
will come down later in the years.
Speaker 3 (09:34):
Here's a listener from bas Drop Yeah near Austin. Yes,
bast Drop. They said, I'm really enjoying your show. Thank
you so much for bringing a show like this. What
do you can you explain? I keep hearing a plan
ABC and D. Can you explain what those are? Yes?
Speaker 4 (09:55):
So plan part A and part B that is your
original Medicare that is the red, white and blue card
that you get from the government when you turn sixty
five or when you enroll into Medicare. That's Part A
and Part B. Part D is prescription drugs D for drugs,
and Part C is combining your Medicare A and B
(10:17):
which is hospital and medical doctors, plus your D drugs
into one plan called the C. So it's A plus
B plus D equals C. Medicare advantage is what it's called,
and it's just all your your medical your prescriptions, but
(10:38):
you get additional benefits like dental and vision and hearing,
and free gym memberships, and some plans even give over
the counter benefits where they give you money to go
buy your allergy medicine ibuprofen and stuff like that.
Speaker 3 (10:51):
So that is the c that makes sense. I like
the way you broke that down. That makes a lot
of sense. A lot of people here about Medicare advantage
and Medicare supplement plans. Can you briefly explain the difference
between the two.
Speaker 4 (11:08):
So the difference is how you get your care. So
Medicare supplement plan is you pay a higher premium every
month in addition to your Medicare premium, so you know,
maybe one hundred and fifty to two hundred dollars a month.
You have a drug a deductible that you have to
pay one time per year, and then after that everything's
(11:30):
covered one hundred percent. Now that's kind of like car
insurance pay you pay it every month. You got to
pay that every month. You may not use it every month,
but you have that there just in case. Medicare advantage
is where you usually don't pay an additional premium, but
then you pay copays as you actually use the services.
(11:53):
If you go the doctor, you pay copey. If you
go to the pharmacy hospital, you pay a copay. If
you go to get an MRI, you pay a copay.
So it's an as needed copey versus supplements. You play
pay ahead. So it's very confusing. A lot of people
call Medicare advantage a supplement, but it's actually not. It's
called the advantage plan. Supplements are where you pay a
(12:16):
little bit higher premium for coverage.
Speaker 3 (12:19):
It's so important to have a good agent, Susan. I
don't know if I would have this problem in Texas,
but I with me. I really liked my orthopedic surgeon,
so I wanted to make sure that he was in
my group, and he was. But when it was time
(12:40):
to use him, my provider said, well, he's not in
our plan, and I'm going but here's his name. Well,
but we have our own pot within the plant. Have
you heard of that before?
Speaker 4 (12:53):
Yeah, So that's called a pod system, And so Florida,
like Texas, has a pod system. And well, mad Medical
Group is one of the kind of hands on gatekeepers
so to speak, for some of the plans. So yes,
even though a doctor may not may be contracted with
(13:17):
Humana or United Healthcare. It depends on who your primary
care doctor falls under. So there's umbrellas of medical groups
and if they fall under a certain umbrella, then they
can refer to that doctor. If they fallow under a
different umbrella and that doctor doesn't reciprocate with that umbrella,
(13:39):
you can't see it. So it's very confusing. That's where
we can kind of navigate and say, Okay, if you
want to go to that doctor, you might have to
change this primary care doctor. So it's complicated. Why they
make it so complicated it shouldn't be, But you know,
I think they just want to confuse people so that
I don't know, so they don't get the care. I'm
(13:59):
not sure, but that's where we come in to make
sure that everything fits like a puzzle piece.
Speaker 3 (14:04):
Here's Manuel in Laredo. First of all, he wants to
know you cover Laredo. And the second question is is
it better to go with a large company versus a
small company because I hear some of the small companies
are either going out of business or pulling out of market.
Speaker 4 (14:27):
Well that's a good question, and yes, I do cover
the whole state of Texas, so Laredo yes, I can
do that. But good question, because funny you should say
pulling out of counties, because it's some of the larger
insurance companies right now that are pulling out of counties.
And I did Healthcare, Blue Cross, Blue Sheeld. Now, yes,
the big names and actually the smaller companies right now
(14:50):
are more stable. So that's the interesting part.
Speaker 3 (14:54):
Yeah, that's amazing. I got to tell you again, folks.
Give First of all, give people because there's a lot
of people listening on radio and Spotify and that don't
see the YouTube scroll. Give people your phone number.
Speaker 4 (15:14):
Sure, My phone number is two one zero seven six
seven nine eight seven six, And I have a team
that if you call us, we can definitely assist you.
You know, it's and we're a free service. That's the
thing is, we don't charge you anything. So even if
you're not sure or you don't have an agent, it's
(15:35):
best if you just review just to make sure, because
you know what, if you go to the doctor or
the pharmacy next year and they say, oh, that medicine's
four hundred dollars, you're like, well, wait a minute, it was.
Speaker 3 (15:47):
Covered last year.
Speaker 4 (15:48):
What do you mean it's because you didn't check.
Speaker 3 (15:51):
It makes sense. How do changes in drug formulas or
network typically affect beneficial year each year to year.
Speaker 4 (16:01):
So every year the drug formulary changes. What's on one
insurance company may be different on the insurance other insurance company.
Drug deductibles increase every year, so Medicare sets the drug deductibles,
which is for next year six hundred and fifteen dollars.
So if you have any high cost medications, what we
(16:25):
look for is to try to find you the least
expensive because if you have to go pay that six
hundred and fifteen dollars out of pocket, the first time
you pick up like an eloquist or a Zerelto or
a trulyicity, then you're going to be like wondering what's
going on. So the drug formularies can change. What was
on a tier one generic could go to a tier two,
(16:48):
or can can take it off the formulary altogether. I've
seen that already twice this year, that penofibrate, which is
a generic and a cyclobenza prene they're not on the
formularies this year.
Speaker 3 (17:00):
If someone is considering, say switching from Medicare Supplement plan
to Medicare Advantage plan, what should they keep in mind
before making that change.
Speaker 4 (17:11):
So to keep in mind, there's two things. One, you
have a Medicare guaranteed issue trial. Right if you've never
been on a Medicare advantage plan and you want to
try a Medicare advantage plan to baby save you some
money but still get the care and extra benefits, you
have one year from January through December to try a
(17:33):
Medicare advantage plan. If at any time throughout that year
you do not like that Medicare advantage plan, you have
a guaranteed issue to go back to that plan that
you were just on. Guaranteed, they cannot ask you health questions,
they cannot deny you, they have to take you back.
So that's a positive, so you can always try it.
(17:53):
And then two, just know that with Medicare supplement versus
Medicare advantage, you want to make sure you're on a
supplement plan, which is like a PPO plan, which means
you don't have to have referrals. You would want to
make sure you go onto a PPO plan just to
have the same kind of flexibility you do on a
supplement plans.
Speaker 3 (18:15):
A hat you keep up with all the different insurance
companies in their plans well, you.
Speaker 4 (18:21):
Know, I've been doing this eleven years, so pretty much
they stay for the most part the same, right, they
just change their benefits here or there, but for the
most part, you know, it's embedded in my brain. I
do this every single day, so I start to memorize
all this stuff. And I can have clients call me
on the way to have a surgery and they're like,
what's my copay And I'm like, you know, two fifty
(18:44):
and they're like, okay, great, thanks. Then they get there like, yeah,
it's two fifty. So I just know all the numbers.
I know all the plans. I know who takes what,
you know, how it's run, how to, how to get
all the information that you need.
Speaker 3 (19:00):
Well, listen, I don't endorse any certain plan. I do
endorse having an agent to help you with this. I said,
I'm on Humana's Advantage Gold Plan. And I got to
tell you, I don't mind admitting things like if I snore,
(19:20):
I'm on a seat pat machine, or if yeah, I'm
losing weight, I'm on Ocemptic. I gotta tell you. With Ocentic,
I was only paying thirty dollars a month out of pocket,
which is amazing and after six months. For the next
six months, I don't have to pay anything.
Speaker 4 (19:41):
Yeah you hit the catastrophic Yeah yeah.
Speaker 3 (19:44):
And my seatpat machine, which they can get pretty pricey.
It pays for that. So I got to tell you,
I've had friends of mine who said they really didn't
care for medicare, especially the ones on HMO where you
have to use a doctor. I got to tell you,
(20:04):
the doctors I've used in my plan have all been wonderful.
I haven't had any bad experiences at all. I know
we've got a question about HMO and PPO. Can you
explain the difference.
Speaker 4 (20:19):
Yes, So, an HMO is a health maintenance organization. It's
where basically your primary care doctor is kind of like
your gatekeeper. They have to refer you out to your specialists,
and they have to be in the network. Okay, you
have to have authorization to go to your cardiologists, your dermatologists,
the endocrinologists. So the primary care doctor is the person
(20:41):
who manages all of that. The cost of HMOs are
a lot cheaper, so you do have cheaper copays and
a little bit more benefits. On an HMO, you do
have worldwide emergencies and nationwide emergencies, but you have to
stay within your service area of where you live for
your doctors and hospitals. Now on a PPO, it's preferred
(21:04):
provider organization, which is kind of like if you've ever
been on employer coverage before. PPO is where you can
come and go to doctors at your leisure. You don't
have to have a referral. You can access doctors all
across the country. There's an in network, there's an out
of network benefit, so you are able to see doctors
(21:25):
in and out of network. You pay a little bit
more on an out of network benefit, but you have
that flexibility. Copays are a little higher, and then you've
got a little bit lesser benefits. But there's no wrong way.
It's just how whatever your doctors are going to take
and is best for you.
Speaker 3 (21:42):
News I must say, I totally understand why you are
so successful. You are so informative, Your show goes by
so fast. Good news is bad news is you are
going to be really busy.
Speaker 4 (21:57):
Starting to say good news.
Speaker 3 (21:59):
Is You're going to be back again with this next month.
Tell everybody how they can reach you.
Speaker 4 (22:04):
Yes, so call us at two one zero, deven six
seven nine eight seven six. You can also go on
our website www dot medicare Gals dash st dot com.
Speaker 3 (22:20):
Susan, you're the best. If you're in the San Antonio
or actually if you listen to us anywhere in Texas today,
but we mostly promote this in San Antonio. Please give
Susan a call. Don't do what I did the first
time and try to do it yourself. Susan, thank you
so much, and we'll see you next month. And hey,
(22:42):
I tell you to stay busy, but I don't have
to do that. Thanks Susan. That's Susan Shimp. Folks, if
you're in the San Antonio area, please give her a call.
If you're if you're getting ready to go on Medicare,
or you're on Medicare and you need to check your policy,
(23:02):
give her a call. Hey, that's going to do it
for us today. We'll be back again with you next
week with the Expert.
Speaker 2 (23:10):
Thanks for tuning in today to the Ask the Expert
Show on the W four CY Radio and Talk for TV.
Tune in next week and every week to hear more
from our experts on personal injury insurance, air condition repairs,
estate planning, medicare, and many other topics in the areas
of legal, health, financial and home improvement. See you next week.
The topics and opinions express in the following show are
solely those of the hosts and their guests and not
those of W FOURCY Radio. It's employees are affiliates. We
make no recommendations or endorsements for radio show programs, services,
or products mentioned on air or on our web. No
liability explicitor implies shall be extended to W FOURCY Radio
or its employees are affiliates. Any questions or comments should
be directed to those show hosts. Thank you for choosing
(00:21):
W FOURCY Radio.
Speaker 2 (00:26):
Welcome to the Ask the Experts Show on W FOURCY
Radio and Talk for TV, where we bring you educational
information from top local experts in the fields of legal, health,
financial and home improvement. Now sit back and listen to
experts in family law, association, law, hearing laws, business brokers,
(00:47):
home care, along with many other topics. Now Here are
your hosts, Spivo and Sophia.
Speaker 3 (00:55):
Hey, good morning, San Antonio. Welcome to another SC expert show.
For the last sixteen years, we have brought you the
top experts in the field of legal, health, financial and
home improvement. Hey, today is a very special day for Medicare.
We are so lucky we got the top Medicare agents
(01:17):
in San Antonio. Listen to this. What a great name
Medicare gals, the Signature team. Let me welcome you to
Susan Ship. Good morning, Susan, good morning.
Speaker 4 (01:30):
How are you?
Speaker 3 (01:31):
I'm good? Are you ready for today?
Speaker 4 (01:34):
Today's gonna be nuts. Since the day that everyone can
start their enrollment into Medicare, change their plans and all
that fun stuff.
Speaker 3 (01:43):
Well, the reason I am so excited about this show.
First of all, you've been asking us to a show
on Medicare for the last four years. We just haven't
had an opening. But I got to tell you I'm
on Medicare showing my age, and I made so many
mistakes that were costly to me, and I don't want
(02:05):
you to make the same mistakes I make. You know,
for you people who are new to Medicare, this is
the greatest show to be watching or listening and tell
us about your company.
Speaker 4 (02:18):
So we are a team of Medicare insurance experts, and
we are passionate about helping people. Medicare is so confusing
to people, and I know you've been through the confusing part,
and you know we just are there to educate and
lend a helping hand. To those who just are very
confused because you've get so much stuff in the mail
(02:39):
on TV and you're like, what's right, what's wrong? You know,
and you want to hear it from someone who's licensed,
local and trusted, and that's what we do. We are
just a local resource in your community to ask questions,
help with anything that you have going on, any issues,
and help with the enrollment process, and we become your
patient advocate so you don't have to call the insurance company.
(03:01):
You call us because we can usually help navigate quicker
than you getting transferred through the insurance company phone lines.
Speaker 3 (03:10):
Susan, we started promoting your show several days ago and
the questions start pouring in, and tell you what people
are confused about all these national commercials and the robo
calls yes and the things that they promise. A lot
of these questions were some of this stuff sounds too
(03:32):
good to be true. But if I'm correct, in Texas,
it's different by county, isn't it.
Speaker 4 (03:41):
The whole entire country is different by county. So that's
the thing is what you see on TV may not
apply to you based on your zip code and based
on your county. So these are national campaigns. And you
know what they do is they want you to call
that phone number. And so you call that phone number
and they look up your zip code and they're like, oh, sorry,
(04:02):
you don't qualify for that, but let me tell you
what you do qualify. So they just dangle that you know,
shiny little object. Yeah, you fall for it, right, and
then they get you into a plan that's not even
good for you. These are national ads, they are not
local ads.
Speaker 3 (04:19):
Susan. I got to say this because it was a
big problem for me. Folks. It's so important that you
get a good agent. Now. I'm gonna tell you why.
My first agent, Susan was horrible. And what I mean
by horrible is they basically showed me one plan when
(04:40):
they could have showed me six or seven plans. And
then when my first year was up, they didn't even
call me. They just assumed I wanted the same plan.
And I have a good agent here in Florida now.
But I know that customer service is so important.
Speaker 4 (04:59):
Absolutely. That's one thing we pride ourselves with is we
are not just one and done. We're with you throughout
the years. We are constantly in contact with you. You
get newsletters from us. You always know, are in the
know when we find out stuff. You know, we do
client reviews with you face to face or over the
phone or via zoom with you every single year. So
(05:21):
right now I'm in the middle of a lot of
client reviews. So we always are with you. We're not
just you know, sign you up and then see you later.
So we are always always with you. And you call us.
You have our cell phone numbers, you have our direct
numbers that you can call us if you have any issues,
any questions. So you know, that's one thing we do
(05:44):
pride ourselves with.
Speaker 3 (05:46):
Somebody wrote a sin who actually called in with the
question wanting to know about changes, and because of when
the show was last month, you couldn't even divulge any
of those shit. Yeah, what kind of changes are we
looking for now?
Speaker 4 (06:04):
So the Medicare premium is increasing, so we know that
that's every year. That's and then there are changes to
a lot of the plans. There are some insurance carriers
that are pulling out of counties the Austin area, San
Antonio area, Waco area. I mean they're just pulling out
(06:26):
because they're not being profitable, so therefore they are terminating plans,
and if you're on one of those plans, then you
might not be covered for next year. So that's why
it's very important to read your letters, read that annual
notice of change that comes out, and honestly, there are
changes to a lot of like the Medicare advantage plans
(06:46):
and the drug plans, increased premiums, increased copays, reduced benefits.
So there's a lot of changes. You just want to
review because what's good this year may not be good
next year.
Speaker 3 (06:59):
I got to tell you here I I'm on Humana,
and I got to tell you this is the reason
why you should check with your agent. Two years ago,
I got glasses. Did not cost me a dime. They
paid for exam everything I went in two days ago
and it was one hundred and seventy dollars. So in
(07:23):
two years it changed, but it shows that's why it's
so important that you did a good agent, because maybe
the plan that was great for you last year might
not be good for you this year. Yes, so what
are the key date of people she remember for this
year's enrollment?
Speaker 4 (07:41):
So today October fifteenth starts your enrollment process to meet
with agents like me and we can reviewer planned and
it runs through December seventh, so you know, you have
about nine weeks of time to do some enrollment. If
after dec Number seventh you don't make a change, there
(08:03):
is an open enrollment period and those are for people
only on Medicare advantage plans from January through March. That
can make another change. So but the key dates really
are October fifteenth through December seventh.
Speaker 3 (08:18):
I got it something funny and I spoke to my agent.
They said, you know you're going to be getting not
a lot more, but a little bit more each month.
It goes to my Social Security. Yes, but I didn't
know is the rates went up, so it kind of
washed that out.
Speaker 4 (08:37):
It's a moot point. You get your cost of living
increase and then the medicure premium increase, and it kind of.
Speaker 3 (08:43):
Washes what are you just out of curiosity. You've heard
the President talk about Pfizer and there's another company just
came out that are going to be reducing a lot
of their products by as much as eighty percent. Well
that current this year?
Speaker 4 (09:01):
No.
Speaker 3 (09:01):
No.
Speaker 4 (09:02):
So that's the thing is like everything's set in stone
for twenty twenty six. It usually takes about two years
for anything any bill to kind of come to fruition. Now,
the thing is is twenty twenty seven. They will start
negotiating twenty twenty seven in February, so they start early.
(09:24):
So right now, no, nothing has changed with the anything
with President Trump with what he did so, but it
will come down later in the years.
Speaker 3 (09:34):
Here's a listener from bas Drop Yeah near Austin. Yes,
bast Drop. They said, I'm really enjoying your show. Thank
you so much for bringing a show like this. What
do you can you explain? I keep hearing a plan
ABC and D. Can you explain what those are? Yes?
Speaker 4 (09:55):
So plan part A and part B that is your
original Medicare that is the red, white and blue card
that you get from the government when you turn sixty
five or when you enroll into Medicare. That's Part A
and Part B. Part D is prescription drugs D for drugs,
and Part C is combining your Medicare A and B
(10:17):
which is hospital and medical doctors, plus your D drugs
into one plan called the C. So it's A plus
B plus D equals C. Medicare advantage is what it's called,
and it's just all your your medical your prescriptions, but
(10:38):
you get additional benefits like dental and vision and hearing,
and free gym memberships, and some plans even give over
the counter benefits where they give you money to go
buy your allergy medicine ibuprofen and stuff like that.
Speaker 3 (10:51):
So that is the c that makes sense. I like
the way you broke that down. That makes a lot
of sense. A lot of people here about Medicare advantage
and Medicare supplement plans. Can you briefly explain the difference
between the two.
Speaker 4 (11:08):
So the difference is how you get your care. So
Medicare supplement plan is you pay a higher premium every
month in addition to your Medicare premium, so you know,
maybe one hundred and fifty to two hundred dollars a month.
You have a drug a deductible that you have to
pay one time per year, and then after that everything's
(11:30):
covered one hundred percent. Now that's kind of like car
insurance pay you pay it every month. You got to
pay that every month. You may not use it every month,
but you have that there just in case. Medicare advantage
is where you usually don't pay an additional premium, but
then you pay copays as you actually use the services.
(11:53):
If you go the doctor, you pay copey. If you
go to the pharmacy hospital, you pay a copay. If
you go to get an MRI, you pay a copay.
So it's an as needed copey versus supplements. You play
pay ahead. So it's very confusing. A lot of people
call Medicare advantage a supplement, but it's actually not. It's
called the advantage plan. Supplements are where you pay a
(12:16):
little bit higher premium for coverage.
Speaker 3 (12:19):
It's so important to have a good agent, Susan. I
don't know if I would have this problem in Texas,
but I with me. I really liked my orthopedic surgeon,
so I wanted to make sure that he was in
my group, and he was. But when it was time
(12:40):
to use him, my provider said, well, he's not in
our plan, and I'm going but here's his name. Well,
but we have our own pot within the plant. Have
you heard of that before?
Speaker 4 (12:53):
Yeah, So that's called a pod system, And so Florida,
like Texas, has a pod system. And well, mad Medical
Group is one of the kind of hands on gatekeepers
so to speak, for some of the plans. So yes,
even though a doctor may not may be contracted with
(13:17):
Humana or United Healthcare. It depends on who your primary
care doctor falls under. So there's umbrellas of medical groups
and if they fall under a certain umbrella, then they
can refer to that doctor. If they fallow under a
different umbrella and that doctor doesn't reciprocate with that umbrella,
(13:39):
you can't see it. So it's very confusing. That's where
we can kind of navigate and say, Okay, if you
want to go to that doctor, you might have to
change this primary care doctor. So it's complicated. Why they
make it so complicated it shouldn't be, But you know,
I think they just want to confuse people so that
I don't know, so they don't get the care. I'm
(13:59):
not sure, but that's where we come in to make
sure that everything fits like a puzzle piece.
Speaker 3 (14:04):
Here's Manuel in Laredo. First of all, he wants to
know you cover Laredo. And the second question is is
it better to go with a large company versus a
small company because I hear some of the small companies
are either going out of business or pulling out of market.
Speaker 4 (14:27):
Well that's a good question, and yes, I do cover
the whole state of Texas, so Laredo yes, I can
do that. But good question, because funny you should say
pulling out of counties, because it's some of the larger
insurance companies right now that are pulling out of counties.
And I did Healthcare, Blue Cross, Blue Sheeld. Now, yes,
the big names and actually the smaller companies right now
(14:50):
are more stable. So that's the interesting part.
Speaker 3 (14:54):
Yeah, that's amazing. I got to tell you again, folks.
Give First of all, give people because there's a lot
of people listening on radio and Spotify and that don't
see the YouTube scroll. Give people your phone number.
Speaker 4 (15:14):
Sure, My phone number is two one zero seven six
seven nine eight seven six, And I have a team
that if you call us, we can definitely assist you.
You know, it's and we're a free service. That's the
thing is, we don't charge you anything. So even if
you're not sure or you don't have an agent, it's
(15:35):
best if you just review just to make sure, because
you know what, if you go to the doctor or
the pharmacy next year and they say, oh, that medicine's
four hundred dollars, you're like, well, wait a minute, it was.
Speaker 3 (15:47):
Covered last year.
Speaker 4 (15:48):
What do you mean it's because you didn't check.
Speaker 3 (15:51):
It makes sense. How do changes in drug formulas or
network typically affect beneficial year each year to year.
Speaker 4 (16:01):
So every year the drug formulary changes. What's on one
insurance company may be different on the insurance other insurance company.
Drug deductibles increase every year, so Medicare sets the drug deductibles,
which is for next year six hundred and fifteen dollars.
So if you have any high cost medications, what we
(16:25):
look for is to try to find you the least
expensive because if you have to go pay that six
hundred and fifteen dollars out of pocket, the first time
you pick up like an eloquist or a Zerelto or
a trulyicity, then you're going to be like wondering what's
going on. So the drug formularies can change. What was
on a tier one generic could go to a tier two,
(16:48):
or can can take it off the formulary altogether. I've
seen that already twice this year, that penofibrate, which is
a generic and a cyclobenza prene they're not on the
formularies this year.
Speaker 3 (17:00):
If someone is considering, say switching from Medicare Supplement plan
to Medicare Advantage plan, what should they keep in mind
before making that change.
Speaker 4 (17:11):
So to keep in mind, there's two things. One, you
have a Medicare guaranteed issue trial. Right if you've never
been on a Medicare advantage plan and you want to
try a Medicare advantage plan to baby save you some
money but still get the care and extra benefits, you
have one year from January through December to try a
(17:33):
Medicare advantage plan. If at any time throughout that year
you do not like that Medicare advantage plan, you have
a guaranteed issue to go back to that plan that
you were just on. Guaranteed, they cannot ask you health questions,
they cannot deny you, they have to take you back.
So that's a positive, so you can always try it.
(17:53):
And then two, just know that with Medicare supplement versus
Medicare advantage, you want to make sure you're on a
supplement plan, which is like a PPO plan, which means
you don't have to have referrals. You would want to
make sure you go onto a PPO plan just to
have the same kind of flexibility you do on a
supplement plans.
Speaker 3 (18:15):
A hat you keep up with all the different insurance
companies in their plans well, you.
Speaker 4 (18:21):
Know, I've been doing this eleven years, so pretty much
they stay for the most part the same, right, they
just change their benefits here or there, but for the
most part, you know, it's embedded in my brain. I
do this every single day, so I start to memorize
all this stuff. And I can have clients call me
on the way to have a surgery and they're like,
what's my copay And I'm like, you know, two fifty
(18:44):
and they're like, okay, great, thanks. Then they get there like, yeah,
it's two fifty. So I just know all the numbers.
I know all the plans. I know who takes what,
you know, how it's run, how to, how to get
all the information that you need.
Speaker 3 (19:00):
Well, listen, I don't endorse any certain plan. I do
endorse having an agent to help you with this. I said,
I'm on Humana's Advantage Gold Plan. And I got to
tell you, I don't mind admitting things like if I snore,
(19:20):
I'm on a seat pat machine, or if yeah, I'm
losing weight, I'm on Ocemptic. I gotta tell you. With Ocentic,
I was only paying thirty dollars a month out of pocket,
which is amazing and after six months. For the next
six months, I don't have to pay anything.
Speaker 4 (19:41):
Yeah you hit the catastrophic Yeah yeah.
Speaker 3 (19:44):
And my seatpat machine, which they can get pretty pricey.
It pays for that. So I got to tell you,
I've had friends of mine who said they really didn't
care for medicare, especially the ones on HMO where you
have to use a doctor. I got to tell you,
(20:04):
the doctors I've used in my plan have all been wonderful.
I haven't had any bad experiences at all. I know
we've got a question about HMO and PPO. Can you
explain the difference.
Speaker 4 (20:19):
Yes, So, an HMO is a health maintenance organization. It's
where basically your primary care doctor is kind of like
your gatekeeper. They have to refer you out to your specialists,
and they have to be in the network. Okay, you
have to have authorization to go to your cardiologists, your dermatologists,
the endocrinologists. So the primary care doctor is the person
(20:41):
who manages all of that. The cost of HMOs are
a lot cheaper, so you do have cheaper copays and
a little bit more benefits. On an HMO, you do
have worldwide emergencies and nationwide emergencies, but you have to
stay within your service area of where you live for
your doctors and hospitals. Now on a PPO, it's preferred
(21:04):
provider organization, which is kind of like if you've ever
been on employer coverage before. PPO is where you can
come and go to doctors at your leisure. You don't
have to have a referral. You can access doctors all
across the country. There's an in network, there's an out
of network benefit, so you are able to see doctors
(21:25):
in and out of network. You pay a little bit
more on an out of network benefit, but you have
that flexibility. Copays are a little higher, and then you've
got a little bit lesser benefits. But there's no wrong way.
It's just how whatever your doctors are going to take
and is best for you.
Speaker 3 (21:42):
News I must say, I totally understand why you are
so successful. You are so informative, Your show goes by
so fast. Good news is bad news is you are
going to be really busy.
Speaker 4 (21:57):
Starting to say good news.
Speaker 3 (21:59):
Is You're going to be back again with this next month.
Tell everybody how they can reach you.
Speaker 4 (22:04):
Yes, so call us at two one zero, deven six
seven nine eight seven six. You can also go on
our website www dot medicare Gals dash st dot com.
Speaker 3 (22:20):
Susan, you're the best. If you're in the San Antonio
or actually if you listen to us anywhere in Texas today,
but we mostly promote this in San Antonio. Please give
Susan a call. Don't do what I did the first
time and try to do it yourself. Susan, thank you
so much, and we'll see you next month. And hey,
(22:42):
I tell you to stay busy, but I don't have
to do that. Thanks Susan. That's Susan Shimp. Folks, if
you're in the San Antonio area, please give her a call.
If you're if you're getting ready to go on Medicare,
or you're on Medicare and you need to check your policy,
(23:02):
give her a call. Hey, that's going to do it
for us today. We'll be back again with you next
week with the Expert.
Speaker 2 (23:10):
Thanks for tuning in today to the Ask the Expert
Show on the W four CY Radio and Talk for TV.
Tune in next week and every week to hear more
from our experts on personal injury insurance, air condition repairs,
estate planning, medicare, and many other topics in the areas
of legal, health, financial and home improvement. See you next week.
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