September 24, 2025 • 22 mins
Open Enrollment 2025 Medicare 2025 San Antonio
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Episode Transcript
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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 explicit or 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
(00:20):
choosing W FOURCY Radio.
Speaker 2 (00:22):
Welcome to the Ask the Experts Show on W four
CY Radio and Talk for TV, where we bring you
educational information from top local experts in the fields of.
Speaker 3 (00:37):
Legal, health, financial and home improvement. Now sit back and
listen to experts in family law, association, law, hearing laws,
business brokers, home care, along with many other topics. Now
Here are your hosts, Spivo and Sophia.
Speaker 4 (00:55):
Hey, good morning, San Antonio. Welcome to another Asked the
Expert Show, where, for the last sixteen years we have
brought you the top experts in the field of legal, health,
financial and home improvement. Hey, this is towards the end
of September. Next month is October and I got to
(01:16):
tell you, if you're at that age for medicare, you
do not want to miss this morning show. And I'm
telling you because I was one of the not so
informed from people about medicare when it was my time,
and it costs me dearly. I wish there would have
(01:36):
been a show like this available to me back then.
Not too far back then, but we found one of
the top agents in the San Antonio area. I love
this name, medicare Gals, the signature team. Let me introduce you.
This is her second show now, and to me, this
(01:58):
is just a special show. So I went through not
understanding Medicare. Good morning, Susan Shimp.
Speaker 5 (02:05):
Good morning, thanks for having me.
Speaker 4 (02:10):
Just complimenting her. She's an hour. We're in the East
Coast and Susan is in the Central time zone, and
she was so vibrant. She's told me she had to
take her daughter to school, so we know she's a
great mom. But Susan, what a great named medicare Gals.
(02:31):
Tell me about your company.
Speaker 5 (02:33):
So, medicare Gals we started in two thousand and fifteen
and it's just a local medicare resource center. It's a
bunch of women and we are just here to basically
help navigate you through the confusing maze of Medicare. There's
(02:54):
so many resources that are left unattended, and we want
to make sure that we address medicare just because it
is complicated.
Speaker 4 (03:05):
Yeah, yeah, I trust me, I know. But I want
to tell people because once in a while online you
hear about people with negative comments about Medicare. I'm gonna
tell you something. I love Medicare. I think it is
It's the greatest we've paid a long time, and I
(03:28):
think that people deserve Medicare, So I want to We're
gonna get probably get rid of some of those myths
that Medicare is not good good. So you know, Susan
I got. I told you. We started promoting your show
a couple of days out, and it's amazing how many
letters we got from people going, please ask your guests
(03:51):
what's the difference between Medicare and medicaid. I can't tell
you how many of those letters have we got.
Speaker 5 (04:00):
It's so confusing, which they would change the names because they.
Speaker 4 (04:04):
Are too similar.
Speaker 5 (04:06):
Right, But Medicare is what the federal government gives you
at the age of sixty five. It's the insurance that
you get automatically. You know, once you turn sixty five,
it's given to you after being paid into so many years.
Medicaid is state funded and it is based on income.
(04:31):
So the lower income then you can apply for Medicaid,
like through the state of Texas. So Medicare is federal,
Medicaid is state and so Medicaid is only based on income.
Speaker 4 (04:46):
You make it so simple. I'm going to say this,
and we try not to commercialize our shows very much,
but I think this is so important. Susion. My first
agent was horrible, and I didn't realize that he was
horrible until after my first year and I started seeing
(05:08):
hearing about what people others get with their Medicare, and
he was I just call him an order taker. He
would just contact me at the end of the year,
and even then sometimes did he even do that. He
just wrote it up without even discussing it with me,
and it does change. So I learned that an agent
(05:31):
is so important. Go to an agent, and you represent
multiple companies, right, that's correct.
Speaker 5 (05:40):
So I'm a broker. I'm contracted with multiple insurance carriers
because one size does not fit all, so one carrier
could be good for you the next could be good
for your spouse or your neighbor. It's all based on prescriptions,
it's all based on your doctors, your financial needs that
(06:02):
you have. So it's really we cater it to you
specifically because there's probably fifty five different plans in the
state of Texas, so there's a lot to choose from,
and you're like, which one do I go for? You know,
So that's where we help guide you and figure out
the best option for you. And I'm your fight fiduciary,
(06:25):
so I'm working with for you, not for the insurance companies,
because you know, they're all pretty much they run the
same way, they give pretty much similar benefits. It's just
what's best for you.
Speaker 4 (06:36):
And you know, from what I understand now doing these shows,
it's actually broken down by your zip code.
Speaker 5 (06:44):
Right, zip code and county yes.
Speaker 4 (06:47):
Yes, So you could be talking to somebody in another
county and comparing notes when it's just it's different, right,
and that plan.
Speaker 5 (06:56):
May not even be in that county, So you know,
it's a lot of it's all Medicare says, you can't
have all the plans in every single county, so they
basically have to pick and choose where they want to
put their plans the insurance carriers.
Speaker 4 (07:14):
Some of these letters that we got for your show
this morning takes me right into my first question, and
it's one that a lot of people have. Now. Annual
enrollment period tell people why that is so important.
Speaker 5 (07:28):
So the annual enrollment period is something that happens every
single year. So twenty twenty six plans get released to
the public October first, So October first is when you
get to see all the new plans coming out for
next year. You probably have already received your annual notice
of change that usually comes late September, but that is
(07:50):
tells you also what is coming for twenty twenty six.
But you can go online. We as agents can also
see what's coming out and we can start running medicaistions.
We could start running all the plans to make sure
going forward for twenty twenty six it's the best plan.
But annual enrollment gives you a chance to review your plan.
So what you have this year for your plan may
(08:13):
not be the best option next year because plans cut benefits,
plans increase copays, plans terminate and exit from counties. And
you think you have the best plan and then you
move forward to twenty twenty six, and if you don't review,
you could be caught with higher costs with medications, you
could lose some benefits, and then sometimes your plan doesn't
(08:36):
even exist January.
Speaker 4 (08:37):
First, and this is going to start next month, right.
Speaker 5 (08:41):
October first, we're a week away.
Speaker 4 (08:44):
Have you seen have you looked at twenty twenty six yet?
Speaker 5 (08:48):
So we do have some sneak peaks that we get
to look at, you know, before the public, because we
have to know what's coming so that we can, you know,
educate our clients. There's chance. Let me just tell you that.
Speaker 4 (09:02):
There's anything big, Susan.
Speaker 5 (09:05):
I can't really discuss until October first, because legally we
are not allowed to. But just if you're in the
Austin area, you might want to contact me because there's
some interesting changes coming on there. The Waco area that's
got some major changes coming. San Antonio's pretty okay, the
(09:29):
benefits are pretty okay. It's just the Austin and the
Waco area that may need some help with their changes
for next year.
Speaker 4 (09:38):
So I think it's really important that people understand that
they might be happy with their current plan, but they
still need to review for twenty twenty six correct, that's.
Speaker 5 (09:51):
Correct, because prescription costs are changing, so what might be
inexpensive this year could cost more, or they may not
that medication may not be on the drug formulay for
next year, and then you go to the pharmacy and
then you're like, it's not covered. What do you mean
it was covered last year. So you just want to
(10:13):
make sure that everything fits, everything is seamless, that you're
not disruptive for twenty twenty six, and yes, please review.
Speaker 4 (10:21):
You know, also a lot of the letters that we've got,
and we've every one of the letters. We send them
your phone number and your contact information. But a lot
of them have seen these ads on TV and I
got to tell you, I think some of them are scams,
(10:44):
to be honest with you. The things they promised, Susan.
Speaker 5 (10:49):
Yeah, they promised, Oh you can get grocery card, you
can get all this stuff, right, Well, there's a catch
to that. Yes, there are some plans that may give
a grocery card. However, if you're low income on Medicaid,
like we talked about in the beginning of the segment,
you're on Medicaid, then yes you can get a food
(11:11):
card if you have certain chronic conditions like diabetes, congestive
heart failure, or cardiovascular disease. You can get a food card,
but only certain plans. Not every plan has that. So
if you do have a chronic condition or you are
low income, there's certain plans that allow you to get
(11:34):
these benefits, but again it doesn't fit everybody, so it
may not be beneficial for you.
Speaker 4 (11:40):
I tell you, speaking of scams, my phone is ringing
off the hook with these robots, you know, and I
want to tell people don't buy into any of those.
So important to get a great agent like Susan. Susan,
(12:00):
I think this year I'm getting more phone calls, these
robot calls than ever before.
Speaker 5 (12:08):
Yes, so yes, I'm not a one a hundred call center.
These one eight hundred call centers basically get sold your information.
So when they get sold your information, they're calling you
and all they care about is their quotas. What are
they going to sell for the day? You know, they
don't care about you. They don't live in the area.
(12:28):
You know, they are just trying to make money. They're
not here for you. So I always say trust a
local agent. If it's not me, just find a local agent,
because they're the ones that are going to know your
doctors in the network, they know the pharmacies, they're going
to know all the plans. These people in you know,
different states and stuff have no idea what's here in
(12:50):
the San Antonio or Texas area.
Speaker 4 (12:52):
You know, I'm going to leave myself out of this.
But what are some of the most common mistakes people
make when it comes to medical enrollment.
Speaker 5 (13:01):
The number one mistake is that they don't review their plan,
so they just let it roll over because they think
it's just fine for them this year, it's going to
be the same next year. So that's the number one
thing that mistakes that people make is they don't review.
So again, we review at a no cost to you,
just to make sure you're on the right plan. If
(13:22):
you're on the right plan, we tell you perfect stay
where you are. But if there's some major changes, you
do want to make sure that you get all your
benefits that you need for next year. There's some cuts
coming down the hatch with some carriers, you know less
than what you have this year, so therefore you do
want to make sure that you do review. But that's
(13:44):
the big mistake is the review.
Speaker 4 (13:47):
And it's okay if you've had a plan that you
were happy with to contact incision because there might even
be better plans out there.
Speaker 5 (14:00):
Yes, so a lot of people are just loyal to
one insurance carrier and they don't know that another insurance
carrier could be better because given more more benefits, but
still cover your doctors and still cover your medications at
low costs. So there's really should not be any loyalty
to one insurance carrier because they all kind of run
(14:23):
the same. It's just what's going to be better for
you in the long run.
Speaker 4 (14:27):
And some of them, because we're dealing with a older audience,
some of them think they're going to be penalized if
they leave the company they're with, and that's not true.
Speaker 5 (14:39):
That's not true at all. These insurance companies know every
single year, this is why they do the annual enrollment
which is October, well technically October fifteenth through December seventh,
but October first is when they get released. But these
insurance companies know this time of year people flip flop
back and forth, so they're always trying to win a customer.
(15:01):
But you know, there's no penalty for you know, switching plans.
It's allowed and they actually encourage it because you know,
we want to make sure that you're getting the better benefit.
And also you can go back to that insurance carrier
back and forth, back and forth, so there's no penalty
just to do what's best for you.
Speaker 4 (15:21):
It's I just want to emphasize one more time, it
is so important that you get an age and Mike
Susan and let them. It doesn't cost you anything, let
them handle it for you. It's because there are so
many companies out there. And I got lucky because after
(15:42):
my first age and I learned a lot and it
was costly because I had it cost me some penalties
and I missed the whole year because of it. This
is so important again. Next month it's the enrollment.
Speaker 5 (15:58):
Right, yeah, October first help and.
Speaker 4 (16:02):
Is there a window season.
Speaker 5 (16:04):
So technically we can start talking about twenty twenty six
October first enrollments into new plans for twenty twenty six
October fifteenth through December seventh, that's every year. That is
the time of year that you're going to get phone calls,
you're going to get mailings, you're going to see TV ads,
You're just going to get bombarded because all the insurance
(16:27):
companies are trying to entice you to come to their plan, right,
But what's on that postcard that you get in the
mail may not be the best option, right. So that's
why I call us and we can help navigate you
through the different plans. And if you say, hey, I
got this postcard from XYZ insurance, can you check it
for me? We can do that. So just make sure
(16:49):
that you're on the best plan.
Speaker 4 (16:51):
Yeah, you know, they'll saying if it sounds too good
to be true, it probably is. It can be Yes,
it's so important. You know. I don't know how much
you can discuss about prescription drug costs. I mean, we
keep hearing that the President's going to get them lowered.
What should listeners know about reviewing their drug covery?
Speaker 5 (17:14):
So the Inflation Reduction Acts started twenty twenty five January
first of twenty twenty five. That's where prescription costs got
reduced to two thousand dollars from eight thousand in twenty
twenty four. But it's going up to twenty one hundred
for twenty twenty six. So I mean it only went up.
Speaker 4 (17:33):
One hundred dollars, but better eight thousand.
Speaker 5 (17:36):
It's better than eight thousand that's for sure. And also
in twenty twenty six is when there's ten medications like
the most prescribed medications like eloquist, zerelto for like apib jardians, trulicity, ozebic,
those for like diabetics are the retail cost is being
negotiated down significantly, so the cost to the consumer as
(18:01):
well as the cost of the insurance company is going
to be a lot less. So we should see a
big difference in those high cost medications for twenty twenty six.
But just know that you're still got a lower cost
when it comes to the complete out of pocket for
your prescription drugs.
Speaker 4 (18:19):
How can people make sure their doctors and hospitals are
still covered under the Medicare advantage plan?
Speaker 5 (18:27):
So I would tell you can call the doctor's office,
but I'll tell you not to because these front desk
office people at the doctor's office most of the time
they have no clue they so they're like, no, we
don't take it, and then they come to me. I'm like,
yes you do. Te So best option is if you
want to find out talk to a local agent. We
(18:47):
can review it and tell you yes they're a network,
no they're not. We need to help you find another doctor,
because the people at the front desks is so much
turnover with them that it's hard to educate the the
front staff of all the insurances that they take. So
I recommend just calling us or calling a local agent
(19:08):
and finding out for yourself.
Speaker 4 (19:10):
I got to tell you it's so. Here's one thing
that happened to me is I found I'm on a
HMO and I love it. There's a lot of people
who want to be able to choose their own doctors.
I had no problem with the doctors and the group,
but Susan, I saw that my doctor, my orthopedic surgeon,
(19:35):
was in the group, and that's one I went with
and come to find out that my main doctor is
in a separate group. I don't know if you've ever
heard of this before that, and they would not let
me go to that doctor, but it showed that he
was part of the group. Have you ever heard of
(19:56):
anything like that?
Speaker 5 (19:57):
Yes, And you're in Flora. So Florida runs similar to Texas.
There's pod systems in Texas as well as in Florida.
So certain medical groups cannot refer to other medical groups. Yeah,
it's like oil and water, right, So that's where us
(20:19):
as agents can tell you yes, you can go see
that doctor because they're affiliated. But San Antonio, Texas, the
whole state Florida very much run the same way with clinics.
They're very much pod systems. So you got to make
sure that the doctors each other.
Speaker 4 (20:38):
Again, we want you to get an agent like doesn't
tell people how they can reach you, so you.
Speaker 5 (20:44):
Can reach me. You can call or text us at
two one zero seven six seven nine eight seven six,
or you can go online to medicare gals dash st
dot com.
Speaker 4 (20:59):
Susan will be with us next month. We'll be in
the middle of it all.
Speaker 6 (21:02):
Next month, we'll be in the midst of it and
that will be going crazy and listen. If you miss
some of the show, you can go back to iHeart
Edicas San Antonio under Ask the Experts.
Speaker 4 (21:15):
That's going to do it for us. Susan, thank you
so much. I can't wait to get together with you
next month and we'll really be in real we'll.
Speaker 5 (21:24):
Know what the plans are doing.
Speaker 4 (21:26):
Yes, yes, thank you, Susan. Thanks, We're going to go
to a break. We'll be right.
Speaker 3 (21:33):
Thanks for tuning in today to the Ask the Expert Show.
On the W four c Y 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
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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 explicit or 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
(00:20):
choosing W FOURCY Radio.
Speaker 2 (00:22):
Welcome to the Ask the Experts Show on W four
CY Radio and Talk for TV, where we bring you
educational information from top local experts in the fields of.
Speaker 3 (00:37):
Legal, health, financial and home improvement. Now sit back and
listen to experts in family law, association, law, hearing laws,
business brokers, home care, along with many other topics. Now
Here are your hosts, Spivo and Sophia.
Speaker 4 (00:55):
Hey, good morning, San Antonio. Welcome to another Asked the
Expert Show, where, for the last sixteen years we have
brought you the top experts in the field of legal, health,
financial and home improvement. Hey, this is towards the end
of September. Next month is October and I got to
(01:16):
tell you, if you're at that age for medicare, you
do not want to miss this morning show. And I'm
telling you because I was one of the not so
informed from people about medicare when it was my time,
and it costs me dearly. I wish there would have
(01:36):
been a show like this available to me back then.
Not too far back then, but we found one of
the top agents in the San Antonio area. I love
this name, medicare Gals, the signature team. Let me introduce you.
This is her second show now, and to me, this
(01:58):
is just a special show. So I went through not
understanding Medicare. Good morning, Susan Shimp.
Speaker 5 (02:05):
Good morning, thanks for having me.
Speaker 4 (02:10):
Just complimenting her. She's an hour. We're in the East
Coast and Susan is in the Central time zone, and
she was so vibrant. She's told me she had to
take her daughter to school, so we know she's a
great mom. But Susan, what a great named medicare Gals.
(02:31):
Tell me about your company.
Speaker 5 (02:33):
So, medicare Gals we started in two thousand and fifteen
and it's just a local medicare resource center. It's a
bunch of women and we are just here to basically
help navigate you through the confusing maze of Medicare. There's
(02:54):
so many resources that are left unattended, and we want
to make sure that we address medicare just because it
is complicated.
Speaker 4 (03:05):
Yeah, yeah, I trust me, I know. But I want
to tell people because once in a while online you
hear about people with negative comments about Medicare. I'm gonna
tell you something. I love Medicare. I think it is
It's the greatest we've paid a long time, and I
(03:28):
think that people deserve Medicare, So I want to We're
gonna get probably get rid of some of those myths
that Medicare is not good good. So you know, Susan
I got. I told you. We started promoting your show
a couple of days out, and it's amazing how many
letters we got from people going, please ask your guests
(03:51):
what's the difference between Medicare and medicaid. I can't tell
you how many of those letters have we got.
Speaker 5 (04:00):
It's so confusing, which they would change the names because they.
Speaker 4 (04:04):
Are too similar.
Speaker 5 (04:06):
Right, But Medicare is what the federal government gives you
at the age of sixty five. It's the insurance that
you get automatically. You know, once you turn sixty five,
it's given to you after being paid into so many years.
Medicaid is state funded and it is based on income.
(04:31):
So the lower income then you can apply for Medicaid,
like through the state of Texas. So Medicare is federal,
Medicaid is state and so Medicaid is only based on income.
Speaker 4 (04:46):
You make it so simple. I'm going to say this,
and we try not to commercialize our shows very much,
but I think this is so important. Susion. My first
agent was horrible, and I didn't realize that he was
horrible until after my first year and I started seeing
(05:08):
hearing about what people others get with their Medicare, and
he was I just call him an order taker. He
would just contact me at the end of the year,
and even then sometimes did he even do that. He
just wrote it up without even discussing it with me,
and it does change. So I learned that an agent
(05:31):
is so important. Go to an agent, and you represent
multiple companies, right, that's correct.
Speaker 5 (05:40):
So I'm a broker. I'm contracted with multiple insurance carriers
because one size does not fit all, so one carrier
could be good for you the next could be good
for your spouse or your neighbor. It's all based on prescriptions,
it's all based on your doctors, your financial needs that
(06:02):
you have. So it's really we cater it to you
specifically because there's probably fifty five different plans in the
state of Texas, so there's a lot to choose from,
and you're like, which one do I go for? You know,
So that's where we help guide you and figure out
the best option for you. And I'm your fight fiduciary,
(06:25):
so I'm working with for you, not for the insurance companies,
because you know, they're all pretty much they run the
same way, they give pretty much similar benefits. It's just
what's best for you.
Speaker 4 (06:36):
And you know, from what I understand now doing these shows,
it's actually broken down by your zip code.
Speaker 5 (06:44):
Right, zip code and county yes.
Speaker 4 (06:47):
Yes, So you could be talking to somebody in another
county and comparing notes when it's just it's different, right,
and that plan.
Speaker 5 (06:56):
May not even be in that county, So you know,
it's a lot of it's all Medicare says, you can't
have all the plans in every single county, so they
basically have to pick and choose where they want to
put their plans the insurance carriers.
Speaker 4 (07:14):
Some of these letters that we got for your show
this morning takes me right into my first question, and
it's one that a lot of people have. Now. Annual
enrollment period tell people why that is so important.
Speaker 5 (07:28):
So the annual enrollment period is something that happens every
single year. So twenty twenty six plans get released to
the public October first, So October first is when you
get to see all the new plans coming out for
next year. You probably have already received your annual notice
of change that usually comes late September, but that is
(07:50):
tells you also what is coming for twenty twenty six.
But you can go online. We as agents can also
see what's coming out and we can start running medicaistions.
We could start running all the plans to make sure
going forward for twenty twenty six it's the best plan.
But annual enrollment gives you a chance to review your plan.
So what you have this year for your plan may
(08:13):
not be the best option next year because plans cut benefits,
plans increase copays, plans terminate and exit from counties. And
you think you have the best plan and then you
move forward to twenty twenty six, and if you don't review,
you could be caught with higher costs with medications, you
could lose some benefits, and then sometimes your plan doesn't
(08:36):
even exist January.
Speaker 4 (08:37):
First, and this is going to start next month, right.
Speaker 5 (08:41):
October first, we're a week away.
Speaker 4 (08:44):
Have you seen have you looked at twenty twenty six yet?
Speaker 5 (08:48):
So we do have some sneak peaks that we get
to look at, you know, before the public, because we
have to know what's coming so that we can, you know,
educate our clients. There's chance. Let me just tell you that.
Speaker 4 (09:02):
There's anything big, Susan.
Speaker 5 (09:05):
I can't really discuss until October first, because legally we
are not allowed to. But just if you're in the
Austin area, you might want to contact me because there's
some interesting changes coming on there. The Waco area that's
got some major changes coming. San Antonio's pretty okay, the
(09:29):
benefits are pretty okay. It's just the Austin and the
Waco area that may need some help with their changes
for next year.
Speaker 4 (09:38):
So I think it's really important that people understand that
they might be happy with their current plan, but they
still need to review for twenty twenty six correct, that's.
Speaker 5 (09:51):
Correct, because prescription costs are changing, so what might be
inexpensive this year could cost more, or they may not
that medication may not be on the drug formulay for
next year, and then you go to the pharmacy and
then you're like, it's not covered. What do you mean
it was covered last year. So you just want to
(10:13):
make sure that everything fits, everything is seamless, that you're
not disruptive for twenty twenty six, and yes, please review.
Speaker 4 (10:21):
You know, also a lot of the letters that we've got,
and we've every one of the letters. We send them
your phone number and your contact information. But a lot
of them have seen these ads on TV and I
got to tell you, I think some of them are scams,
(10:44):
to be honest with you. The things they promised, Susan.
Speaker 5 (10:49):
Yeah, they promised, Oh you can get grocery card, you
can get all this stuff, right, Well, there's a catch
to that. Yes, there are some plans that may give
a grocery card. However, if you're low income on Medicaid,
like we talked about in the beginning of the segment,
you're on Medicaid, then yes you can get a food
(11:11):
card if you have certain chronic conditions like diabetes, congestive
heart failure, or cardiovascular disease. You can get a food card,
but only certain plans. Not every plan has that. So
if you do have a chronic condition or you are
low income, there's certain plans that allow you to get
(11:34):
these benefits, but again it doesn't fit everybody, so it
may not be beneficial for you.
Speaker 4 (11:40):
I tell you, speaking of scams, my phone is ringing
off the hook with these robots, you know, and I
want to tell people don't buy into any of those.
So important to get a great agent like Susan. Susan,
(12:00):
I think this year I'm getting more phone calls, these
robot calls than ever before.
Speaker 5 (12:08):
Yes, so yes, I'm not a one a hundred call center.
These one eight hundred call centers basically get sold your information.
So when they get sold your information, they're calling you
and all they care about is their quotas. What are
they going to sell for the day? You know, they
don't care about you. They don't live in the area.
(12:28):
You know, they are just trying to make money. They're
not here for you. So I always say trust a
local agent. If it's not me, just find a local agent,
because they're the ones that are going to know your
doctors in the network, they know the pharmacies, they're going
to know all the plans. These people in you know,
different states and stuff have no idea what's here in
(12:50):
the San Antonio or Texas area.
Speaker 4 (12:52):
You know, I'm going to leave myself out of this.
But what are some of the most common mistakes people
make when it comes to medical enrollment.
Speaker 5 (13:01):
The number one mistake is that they don't review their plan,
so they just let it roll over because they think
it's just fine for them this year, it's going to
be the same next year. So that's the number one
thing that mistakes that people make is they don't review.
So again, we review at a no cost to you,
just to make sure you're on the right plan. If
(13:22):
you're on the right plan, we tell you perfect stay
where you are. But if there's some major changes, you
do want to make sure that you get all your
benefits that you need for next year. There's some cuts
coming down the hatch with some carriers, you know less
than what you have this year, so therefore you do
want to make sure that you do review. But that's
(13:44):
the big mistake is the review.
Speaker 4 (13:47):
And it's okay if you've had a plan that you
were happy with to contact incision because there might even
be better plans out there.
Speaker 5 (14:00):
Yes, so a lot of people are just loyal to
one insurance carrier and they don't know that another insurance
carrier could be better because given more more benefits, but
still cover your doctors and still cover your medications at
low costs. So there's really should not be any loyalty
to one insurance carrier because they all kind of run
(14:23):
the same. It's just what's going to be better for
you in the long run.
Speaker 4 (14:27):
And some of them, because we're dealing with a older audience,
some of them think they're going to be penalized if
they leave the company they're with, and that's not true.
Speaker 5 (14:39):
That's not true at all. These insurance companies know every
single year, this is why they do the annual enrollment
which is October, well technically October fifteenth through December seventh,
but October first is when they get released. But these
insurance companies know this time of year people flip flop
back and forth, so they're always trying to win a customer.
(15:01):
But you know, there's no penalty for you know, switching plans.
It's allowed and they actually encourage it because you know,
we want to make sure that you're getting the better benefit.
And also you can go back to that insurance carrier
back and forth, back and forth, so there's no penalty
just to do what's best for you.
Speaker 4 (15:21):
It's I just want to emphasize one more time, it
is so important that you get an age and Mike
Susan and let them. It doesn't cost you anything, let
them handle it for you. It's because there are so
many companies out there. And I got lucky because after
(15:42):
my first age and I learned a lot and it
was costly because I had it cost me some penalties
and I missed the whole year because of it. This
is so important again. Next month it's the enrollment.
Speaker 5 (15:58):
Right, yeah, October first help and.
Speaker 4 (16:02):
Is there a window season.
Speaker 5 (16:04):
So technically we can start talking about twenty twenty six
October first enrollments into new plans for twenty twenty six
October fifteenth through December seventh, that's every year. That is
the time of year that you're going to get phone calls,
you're going to get mailings, you're going to see TV ads,
You're just going to get bombarded because all the insurance
(16:27):
companies are trying to entice you to come to their plan, right,
But what's on that postcard that you get in the
mail may not be the best option, right. So that's
why I call us and we can help navigate you
through the different plans. And if you say, hey, I
got this postcard from XYZ insurance, can you check it
for me? We can do that. So just make sure
(16:49):
that you're on the best plan.
Speaker 4 (16:51):
Yeah, you know, they'll saying if it sounds too good
to be true, it probably is. It can be Yes,
it's so important. You know. I don't know how much
you can discuss about prescription drug costs. I mean, we
keep hearing that the President's going to get them lowered.
What should listeners know about reviewing their drug covery?
Speaker 5 (17:14):
So the Inflation Reduction Acts started twenty twenty five January
first of twenty twenty five. That's where prescription costs got
reduced to two thousand dollars from eight thousand in twenty
twenty four. But it's going up to twenty one hundred
for twenty twenty six. So I mean it only went up.
Speaker 4 (17:33):
One hundred dollars, but better eight thousand.
Speaker 5 (17:36):
It's better than eight thousand that's for sure. And also
in twenty twenty six is when there's ten medications like
the most prescribed medications like eloquist, zerelto for like apib jardians, trulicity, ozebic,
those for like diabetics are the retail cost is being
negotiated down significantly, so the cost to the consumer as
(18:01):
well as the cost of the insurance company is going
to be a lot less. So we should see a
big difference in those high cost medications for twenty twenty six.
But just know that you're still got a lower cost
when it comes to the complete out of pocket for
your prescription drugs.
Speaker 4 (18:19):
How can people make sure their doctors and hospitals are
still covered under the Medicare advantage plan?
Speaker 5 (18:27):
So I would tell you can call the doctor's office,
but I'll tell you not to because these front desk
office people at the doctor's office most of the time
they have no clue they so they're like, no, we
don't take it, and then they come to me. I'm like,
yes you do. Te So best option is if you
want to find out talk to a local agent. We
(18:47):
can review it and tell you yes they're a network,
no they're not. We need to help you find another doctor,
because the people at the front desks is so much
turnover with them that it's hard to educate the the
front staff of all the insurances that they take. So
I recommend just calling us or calling a local agent
(19:08):
and finding out for yourself.
Speaker 4 (19:10):
I got to tell you it's so. Here's one thing
that happened to me is I found I'm on a
HMO and I love it. There's a lot of people
who want to be able to choose their own doctors.
I had no problem with the doctors and the group,
but Susan, I saw that my doctor, my orthopedic surgeon,
(19:35):
was in the group, and that's one I went with
and come to find out that my main doctor is
in a separate group. I don't know if you've ever
heard of this before that, and they would not let
me go to that doctor, but it showed that he
was part of the group. Have you ever heard of
(19:56):
anything like that?
Speaker 5 (19:57):
Yes, And you're in Flora. So Florida runs similar to Texas.
There's pod systems in Texas as well as in Florida.
So certain medical groups cannot refer to other medical groups. Yeah,
it's like oil and water, right, So that's where us
(20:19):
as agents can tell you yes, you can go see
that doctor because they're affiliated. But San Antonio, Texas, the
whole state Florida very much run the same way with clinics.
They're very much pod systems. So you got to make
sure that the doctors each other.
Speaker 4 (20:38):
Again, we want you to get an agent like doesn't
tell people how they can reach you, so you.
Speaker 5 (20:44):
Can reach me. You can call or text us at
two one zero seven six seven nine eight seven six,
or you can go online to medicare gals dash st
dot com.
Speaker 4 (20:59):
Susan will be with us next month. We'll be in
the middle of it all.
Speaker 6 (21:02):
Next month, we'll be in the midst of it and
that will be going crazy and listen. If you miss
some of the show, you can go back to iHeart
Edicas San Antonio under Ask the Experts.
Speaker 4 (21:15):
That's going to do it for us. Susan, thank you
so much. I can't wait to get together with you
next month and we'll really be in real we'll.
Speaker 5 (21:24):
Know what the plans are doing.
Speaker 4 (21:26):
Yes, yes, thank you, Susan. Thanks, We're going to go
to a break. We'll be right.
Speaker 3 (21:33):
Thanks for tuning in today to the Ask the Expert Show.
On the W four c Y 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 improvements. See you next week.
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