Episode Transcript
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Speaker 1 (00:01):
Welcome to Medicare three sixty, where the world of medicare
is simplified and you are empowered to make informed healthcare choices.
With over two decades of experience and insurance and financial solutions.
With host licensed insurance agents Jennifer Lee, you are guided
through the ins and outs of medicare, whether you are
(00:22):
nearing retirement, navigating your options, or just curious about what's available.
Everything you need to know is covered. Tune in for
knowledgeable insights, tips and answers to your Medicare questions so
you can take charge of your health and your future.
And now Medicare three sixty.
Speaker 2 (00:45):
Welcome to another episode of Medicare three sixty Radio. I'm
your host, Jennifer Fonso Lee, founder of Premier three sixty
Insurance and financial Solutions. Today we're diving into one of
the biggest and least understood issues and met.
Speaker 3 (01:00):
Care right now.
Speaker 2 (01:02):
Insurance companies and medical groups renegotiating and terminating contracts for January. First,
so let me go over that. Insurance companies and medical groups,
some of them their contracts are coming due.
Speaker 3 (01:22):
So when a contract comes.
Speaker 2 (01:24):
Due, they negotiate the terms on that contract and sometimes
they do agree into the terms of that agreement.
Speaker 3 (01:35):
More likely the pay and how much.
Speaker 2 (01:40):
Medical groups will get from these insurance companies, and if
they don't come into an agreement, then they will have
to terminate. And right now, luckily most of them contracts
if terming would be for January first. I know clients
(02:01):
are very upset about this. It's you know, we're almost
halfway through annual enrollment season and to put this change.
But on the positive side, there is time to help
a member with their plan. That's one right. I've seen
it where contract negotiations happen mid year and it is
(02:28):
a tough situation when that happens.
Speaker 3 (02:31):
So if you.
Speaker 2 (02:32):
Received a letter saying your doctor, hospital, or medical group
will be out of network, this episode is for you.
Will break down what's happening, why it's happening, and exactly
what you could do to protect your care. Every fall,
insurance companies and medical groups across the country renegategotiate contracts
(02:58):
for the upcoming year. Of course, sometimes this is not
even at the end of the year. It could be
mid year, so that's to me crazy. I think there
should be regulation on that, so it really doesn't disrupt
care for a whole year for a client. Okay, so
(03:19):
who does this affect. It affects Medicare advantage, HMOs, nppos,
medical groups, and IPA's large hospital systems, multi specialty clinics,
specialists like cardiologists, oncologists, orthopedics.
Speaker 3 (03:37):
So when negotiations.
Speaker 2 (03:39):
Break down or when one side decides payments aren't fair,
contracts could get terminated or not renewed. This is exactly
what we're seeing now, and unfortunately, I've seen it more
and more often as the years go by. So these disputes,
(04:01):
they usually involve reimbursement rates, prior authorization burdens, patient volume,
financial rist sharing, and seniors end up caught in the
middle of this, which is very unfortunate.
Speaker 3 (04:20):
I've seen.
Speaker 2 (04:22):
Medical groups, large ones that are not even wanting to
accept patients. So I think the Medicare system is broken.
But that is definitely another topic I would say. I mean,
this is this is a big topic, actually, so let
(04:45):
us continue. Okay, so how does this affect seniors? If
your plan or medical group contract is terminated on January First,
here's what it means for you. Your lock DOP may
no longer be a network. If you are in an HMO,
(05:06):
this means you cannot continue seeing that doctor without paying
full cost. So keep in mind it is out of
your pocket, not the insurance. So please make sure that
if you are on a HMO, you can see your
doctor still. If you're in a PPO, you may still
(05:28):
see them, but maybe at a higher out of pocket
network rate. So your referrals may be canceled. If your
medical group isn't contracted, referrals to specialists imaging and therapy
often get denied. Your hospital access may change. Many seniors
(05:49):
learn the hard way that their plan no longer has
access to the preferred hospital or surgery centers. That's a
big one too. Your care could be disrupted. Switching doctors,
restarting referrals, or waiting for authorizations can delay treatment, especially
for those or chronic or serious conditions. That's why it's
(06:13):
so important to act early when you receive a change letter.
And I know sometimes people don't really read their mail
because they're junk because they get millions of letters, right,
or they don't listen to their phone calls because they're
just inundated right with too many Medicare calls. But please
(06:36):
review your letter, your communications from your provider. So what
do you do if you do get a termination letter.
If your doctor or medical group sends you a letter,
don't panic, but take it seriously. That's the biggest thing
(06:57):
to see Seniors that are much older, that have been
on their plans for twenty even thirty years, that this
affects them even more, and luckily you know, they do
reach out. But that's another conversation. Let me just finish
(07:18):
this up. Okay, So what should you do? Step one?
Read the letter carefully. They'll tell you the exact date
the contract ends, typically usually January first, and so what
can you do? You could definitely call your doctor's office,
ask them to make sure they're moving medical groups, are
(07:40):
they joining different plans? Will you remain will they remain
on your insurance right? So, sometimes terminations only affect certain plans,
not all, but sometimes it could be the whole insurance
company not taking that plan. So step three, call your
insurance plan ass the plan is a termination finalized, our
(08:03):
negotiations ongoing? Is there a continuity of care exception? So
the biggest thing on this is sometimes when you call
the insurance company that is terming the contract with the
provider first, you might be getting someone at a call
(08:24):
center on the other side of the nation and they
have no clue or have no idea what's going on.
So in their system everything looks good. Maybe they didn't
get a memo on it, or sometimes they'll persuade you
(08:45):
to move to a different medical group right to stay
on the insurance plan. That's the second thing. But when
that happens, you really need to make sure that you
like your medical group, that the hospitals.
Speaker 3 (09:00):
That are in.
Speaker 2 (09:01):
Network is up to your standards.
Speaker 3 (09:04):
So that is definitely a big thing.
Speaker 2 (09:06):
So there is a lot of confusion in there because
your medical group in your doctor's office will tell you
one thing, and maybe that insurance company doesn't a know
what's really going on because they have what thousands of
customer service reps that may not have got the memo
(09:28):
or you know, they're trying to pursue you to stay
with them right and change doctors, medical groups, and hospitals.
So know your enrollment options. If your doctor is important
to you, you may be able to change to a
Medicare advantage plan that still contracts with your doctor, switch
(09:51):
to your people are broader access, return to original Medicare
during searching periods, or join in you group that your
doctor is moving to So the biggest thing is it
does quite get confusing, So get that help, get that
help from a licensed insurance agent as myself to help
(10:14):
you get that. This is where having an advisor matters,
someone who knows the local networks and the changes happening
between the scenes.
Speaker 3 (10:27):
So that's the biggest thing.
Speaker 2 (10:29):
Right Sometimes your medical group or your doctor does work
with an independent agent that may assist you. That could
happen and so definitely or you know you may be
working with an agent right now. So continuity of care
(10:54):
your protected rights. Let's go over this because it is important.
This is one of those most thinks seniors overlook. If
you're in the middle of an active treatment, you may
qualify for continuity of care. This means you can continue
seeing your doctor temporarily even if you're no longer a network.
(11:18):
So you may qualify if.
Speaker 3 (11:21):
You are pregnant.
Speaker 2 (11:22):
I don't think many seniors are pregnant, are ongoing cancer
treatments recently at surgery, are on dialysis, are hospitalized, require
ongoing infusion therapy, are in hospice, have a complex chronic condition.
(11:43):
So to request this, you must contact your insurance plan
tell them you want a transitional continuity of care and
have your doctor submit documentations. So not everyone qualifies, but
many do and it buys you some time. So please
keep that in mind and make sure you have that
(12:07):
earlier because there are like your doctor has to submit
documentation on this. So how these contract changes affect medication.
Contract terminations just don't affect doctors. They also affect pharmacy
networks and specialty drug approvals.
Speaker 3 (12:27):
So if your medical.
Speaker 2 (12:28):
Group changes, you may need new prior authorizations, new referrals,
new pharmacy instructions, new specialists approval pathway. This can delay
medications if you don't plan ahead so rely on specialty drugs.
So if you do rely on specialty drugs, start reviewing
(12:48):
your plan now, not in December. The biggest thing too
is I would make sure to get like an extra
set of refills by the end of the year so
you just aren't stressed.
Speaker 3 (13:00):
Out that you need your medication.
Speaker 2 (13:04):
At that time. So let's talk about the insulin savings program.
Let's take a moment to remind everyone about the thirty
five dollars insulin Savings program. Regardless of what part deep
pan you have, what Medicare advantaged plan, you're on whether
you've hit your deductible. Your insulin cannot cost more than
(13:24):
thirty five dollars per month. If you're paying more, that's
a sign something needs to be reviewed. And with contract
terminations happening, this is a perfect time to double.
Speaker 3 (13:37):
Check your DRIG list.
Speaker 2 (13:40):
So how to appeal a denied claim or medication? When
contracts change, denials often spike because referrals and authorizations don't
transfer smoothly. So let's go quickly over that. On how
to find file on Medicare appeal. Get your explanation of benefits.
(14:02):
It will show you exactly why something was denied. Step
two follow the first level appeal. You do have sixty days,
but I would just do it as soon as possible.
Submit a written letter, a doctor support note, any clinical documentation. Naturally,
you can file an appeal by just calling the insurance company,
(14:24):
so that's the first option I would say. So if
it is denied again, you do it independent review. This
is handled by an outside medical reviewer and not your plan.
Speaker 3 (14:39):
And then es kalate if needed.
Speaker 2 (14:43):
You could appeal all the ways to all the way
to the Medicare Appeals Council. Many seniors simply when simply
because they took the time to fight it. If you're confused,
call someone experience. We walk clients through appeals all the time,
so please keep in mind on that as well. So
(15:05):
just kind of the state of everything, depending on you're
part of the world or nation, right, this has been
going on for quite some years now. Some some you
knowed uh, some plans are getting terminated not terminated, sorry.
(15:29):
Some insurance companies and medical groups are terming contracts right,
So it does happen across the nation. So what I
definitely suggest is that you read your mail. You make
sure that you're reading it correctly. There are sometimes where
(15:50):
maybe a specific subgroup of patients like a like a
group ppo plan or individual maybe under sixty five is
not included in the termination, so you also need to
look out for that to make sure. If you do
(16:11):
have relatives, friends, family, there is always you know, talk right.
Sometimes rumors are true and sometimes they are not true.
So talk to a reliable local source like your medical group,
(16:33):
your office, your doctor's office, the insurance company, and just
make sure all your ducks are lined up in a row.
Speaker 3 (16:44):
I know it is.
Speaker 2 (16:45):
Very inconvenient, especially if you are going through surgery or
post surgery to figure this out. That's why the continuation
of care is very important. To go over that within
insurance company and make sure that you got the documentation
and all that approved with them. Let's see, contract fights
(17:12):
between insurance companies and medical groups are just really becoming
more common and they create real stress for seniors. So today, please,
you have options, you do have rights, and you do
not have to navigate these changes alone. Whether you receive
(17:37):
determination letter or need to help reviewing your plan, or
want guidance or appeals or medication costs. My team at
Premiere three sixty are here to help. We do help
you and schedule your free Medicare review and we definitely
want to make sure you stay informed, empowered and stayed healthy.
(18:07):
Medicare rates actually have come out, so it would behove
me to actually go over it with you guys. Right, Okay,
so before we end, let me go over that because
I'm sure everyone is dying to know. So next week
I will go over it in more detail. But the
(18:28):
biggest thing is that your part by premium rate will
go up to two hundred two dollars and ninety cents.
That's up from one eighty five. So what is that
two two ninety minus one eighty five went up seventeen
(18:51):
dollars and ninety cents. I know COLA did go up
as well at two point six percent. Your part B
deductible is at two eighty three this year is at
two fifty seven. So those are those with a Medicare
supplement plan or a MEDIGAP plan that also has gone up.
(19:17):
What else is there? So of course if you have IRMA,
that has always also gone up as well.
Speaker 3 (19:26):
So the highest.
Speaker 2 (19:27):
Earn IRMA you will pay next year if you're in
the highest tax bracket, would be seven hundred eighty dollars
and ninety cents. So keep definitely keep this in mind. Okay,
(19:57):
I mean not a surprise that our premiums are going up, right,
It's just really not a surprise. But just overall, I
know many are very concerned with the stability of health
(20:20):
insurance and Medicare, but I don't think the government would
like upset seniors. So while rates may go up these
contract negotiations, my term you know, healthcare and your Medicare
(20:41):
is still here, different topic. I believe it is really broken.
But so the biggest takeaway I would say today too,
especially if you have an elderly parent.
Speaker 3 (20:57):
Or someone you are the caregiver to.
Speaker 2 (21:01):
Is that we do have a lot of sharp seniors
that are on top of this, but I am definitely
concerned with the seniors that don't read their nail don't
answer their phone. They might be in quite a shock
next year because if they do go to the doctor,
(21:22):
or you know, even if they didn't go to the
doctor and they went to the hospital, and it may
not be a network of course for emergencies, you could
go anywhere, it might be a shock. We are coming
up to December seventh, so we don't have much time,
but we definitely make it as easy and possible for
(21:43):
you to get the care you would like and maintain
a care that you've been receiving if that will help.
So please, if you are a caregiar or helping your
parents out, make sure you get all their ducks in
(22:09):
a row, meaning the best thing is to get all
their medication, all their doctors and specialists, including their dentists,
and letting your agent know if they have any other ailments,
(22:30):
chronic conditions, or if they have upcoming surgery or the
chronic conditions because that will help. And if they're on
Medicaid slash Medical in California, because that will definitely help
determine which plans, if any, they could go on. And unfortunately,
sometimes just even doctors themselves will terminate contracts, and it's
(22:55):
very unfortunate, especially if you're not in a metropolitan area,
that the pull of plans get smaller and smaller and
you really don't have much choices, which is very unfortunate.
But we are definitely here to guide you and all
that I know, this is probably not an uplifting episode.
(23:21):
It is very concerning that this is happening across a nation.
But as I mentioned, we're here to help you navigate
through this process to make sure that you are receiving
the level of care that you want and that you're
accustomed to along all these years. So please, if you
(23:49):
do need help with that, give us a call. We
will definitely help review your doctors, your medical group, advice
on appeals, medication cost. We're really here to help, so
schedule your free Medicare review. So this is Jennifer al
(24:10):
Fonso Flee and thank you for joining me on Medicare
three sixty show. Stay informed, stay empowered, and stay healthy.
Speaker 3 (24:19):
You have a great day.
Speaker 1 (24:23):
Thank you for joining the program Medicare three sixty. Hope
you found today's episode insightful and empowering. Remember, understanding your
Medicare options is key to making the right choices for
your health and financial well being. If you have questions
or topics you would like covered in future episodes of
Medicare three sixty, don't hesitate to reach out and speak
(24:46):
with our licensed insurance agent Until next time, Stay informed
and take charge of your healthcare journey. This has been
Medicare three sixty, your trusted source for all things Medicare.
Take care
Welcome to Medicare three sixty, where the world of medicare
is simplified and you are empowered to make informed healthcare choices.
With over two decades of experience and insurance and financial solutions.
With host licensed insurance agents Jennifer Lee, you are guided
through the ins and outs of medicare, whether you are
(00:22):
nearing retirement, navigating your options, or just curious about what's available.
Everything you need to know is covered. Tune in for
knowledgeable insights, tips and answers to your Medicare questions so
you can take charge of your health and your future.
And now Medicare three sixty.
Speaker 2 (00:45):
Welcome to another episode of Medicare three sixty Radio. I'm
your host, Jennifer Fonso Lee, founder of Premier three sixty
Insurance and financial Solutions. Today we're diving into one of
the biggest and least understood issues and met.
Speaker 3 (01:00):
Care right now.
Speaker 2 (01:02):
Insurance companies and medical groups renegotiating and terminating contracts for January. First,
so let me go over that. Insurance companies and medical groups,
some of them their contracts are coming due.
Speaker 3 (01:22):
So when a contract comes.
Speaker 2 (01:24):
Due, they negotiate the terms on that contract and sometimes
they do agree into the terms of that agreement.
Speaker 3 (01:35):
More likely the pay and how much.
Speaker 2 (01:40):
Medical groups will get from these insurance companies, and if
they don't come into an agreement, then they will have
to terminate. And right now, luckily most of them contracts
if terming would be for January first. I know clients
(02:01):
are very upset about this. It's you know, we're almost
halfway through annual enrollment season and to put this change.
But on the positive side, there is time to help
a member with their plan. That's one right. I've seen
it where contract negotiations happen mid year and it is
(02:28):
a tough situation when that happens.
Speaker 3 (02:31):
So if you.
Speaker 2 (02:32):
Received a letter saying your doctor, hospital, or medical group
will be out of network, this episode is for you.
Will break down what's happening, why it's happening, and exactly
what you could do to protect your care. Every fall,
insurance companies and medical groups across the country renegategotiate contracts
(02:58):
for the upcoming year. Of course, sometimes this is not
even at the end of the year. It could be
mid year, so that's to me crazy. I think there
should be regulation on that, so it really doesn't disrupt
care for a whole year for a client. Okay, so
(03:19):
who does this affect. It affects Medicare advantage, HMOs, nppos,
medical groups, and IPA's large hospital systems, multi specialty clinics,
specialists like cardiologists, oncologists, orthopedics.
Speaker 3 (03:37):
So when negotiations.
Speaker 2 (03:39):
Break down or when one side decides payments aren't fair,
contracts could get terminated or not renewed. This is exactly
what we're seeing now, and unfortunately, I've seen it more
and more often as the years go by. So these disputes,
(04:01):
they usually involve reimbursement rates, prior authorization burdens, patient volume,
financial rist sharing, and seniors end up caught in the
middle of this, which is very unfortunate.
Speaker 3 (04:20):
I've seen.
Speaker 2 (04:22):
Medical groups, large ones that are not even wanting to
accept patients. So I think the Medicare system is broken.
But that is definitely another topic I would say. I mean,
this is this is a big topic, actually, so let
(04:45):
us continue. Okay, so how does this affect seniors? If
your plan or medical group contract is terminated on January First,
here's what it means for you. Your lock DOP may
no longer be a network. If you are in an HMO,
(05:06):
this means you cannot continue seeing that doctor without paying
full cost. So keep in mind it is out of
your pocket, not the insurance. So please make sure that
if you are on a HMO, you can see your
doctor still. If you're in a PPO, you may still
(05:28):
see them, but maybe at a higher out of pocket
network rate. So your referrals may be canceled. If your
medical group isn't contracted, referrals to specialists imaging and therapy
often get denied. Your hospital access may change. Many seniors
(05:49):
learn the hard way that their plan no longer has
access to the preferred hospital or surgery centers. That's a
big one too. Your care could be disrupted. Switching doctors,
restarting referrals, or waiting for authorizations can delay treatment, especially
for those or chronic or serious conditions. That's why it's
(06:13):
so important to act early when you receive a change letter.
And I know sometimes people don't really read their mail
because they're junk because they get millions of letters, right,
or they don't listen to their phone calls because they're
just inundated right with too many Medicare calls. But please
(06:36):
review your letter, your communications from your provider. So what
do you do if you do get a termination letter.
If your doctor or medical group sends you a letter,
don't panic, but take it seriously. That's the biggest thing
(06:57):
to see Seniors that are much older, that have been
on their plans for twenty even thirty years, that this
affects them even more, and luckily you know, they do
reach out. But that's another conversation. Let me just finish
(07:18):
this up. Okay, So what should you do? Step one?
Read the letter carefully. They'll tell you the exact date
the contract ends, typically usually January first, and so what
can you do? You could definitely call your doctor's office,
ask them to make sure they're moving medical groups, are
(07:40):
they joining different plans? Will you remain will they remain
on your insurance right? So, sometimes terminations only affect certain plans,
not all, but sometimes it could be the whole insurance
company not taking that plan. So step three, call your
insurance plan ass the plan is a termination finalized, our
(08:03):
negotiations ongoing? Is there a continuity of care exception? So
the biggest thing on this is sometimes when you call
the insurance company that is terming the contract with the
provider first, you might be getting someone at a call
(08:24):
center on the other side of the nation and they
have no clue or have no idea what's going on.
So in their system everything looks good. Maybe they didn't
get a memo on it, or sometimes they'll persuade you
(08:45):
to move to a different medical group right to stay
on the insurance plan. That's the second thing. But when
that happens, you really need to make sure that you
like your medical group, that the hospitals.
Speaker 3 (09:00):
That are in.
Speaker 2 (09:01):
Network is up to your standards.
Speaker 3 (09:04):
So that is definitely a big thing.
Speaker 2 (09:06):
So there is a lot of confusion in there because
your medical group in your doctor's office will tell you
one thing, and maybe that insurance company doesn't a know
what's really going on because they have what thousands of
customer service reps that may not have got the memo
(09:28):
or you know, they're trying to pursue you to stay
with them right and change doctors, medical groups, and hospitals.
So know your enrollment options. If your doctor is important
to you, you may be able to change to a
Medicare advantage plan that still contracts with your doctor, switch
(09:51):
to your people are broader access, return to original Medicare
during searching periods, or join in you group that your
doctor is moving to So the biggest thing is it
does quite get confusing, So get that help, get that
help from a licensed insurance agent as myself to help
(10:14):
you get that. This is where having an advisor matters,
someone who knows the local networks and the changes happening
between the scenes.
Speaker 3 (10:27):
So that's the biggest thing.
Speaker 2 (10:29):
Right Sometimes your medical group or your doctor does work
with an independent agent that may assist you. That could
happen and so definitely or you know you may be
working with an agent right now. So continuity of care
(10:54):
your protected rights. Let's go over this because it is important.
This is one of those most thinks seniors overlook. If
you're in the middle of an active treatment, you may
qualify for continuity of care. This means you can continue
seeing your doctor temporarily even if you're no longer a network.
(11:18):
So you may qualify if.
Speaker 3 (11:21):
You are pregnant.
Speaker 2 (11:22):
I don't think many seniors are pregnant, are ongoing cancer
treatments recently at surgery, are on dialysis, are hospitalized, require
ongoing infusion therapy, are in hospice, have a complex chronic condition.
(11:43):
So to request this, you must contact your insurance plan
tell them you want a transitional continuity of care and
have your doctor submit documentations. So not everyone qualifies, but
many do and it buys you some time. So please
keep that in mind and make sure you have that
(12:07):
earlier because there are like your doctor has to submit
documentation on this. So how these contract changes affect medication.
Contract terminations just don't affect doctors. They also affect pharmacy
networks and specialty drug approvals.
Speaker 3 (12:27):
So if your medical.
Speaker 2 (12:28):
Group changes, you may need new prior authorizations, new referrals,
new pharmacy instructions, new specialists approval pathway. This can delay
medications if you don't plan ahead so rely on specialty drugs.
So if you do rely on specialty drugs, start reviewing
(12:48):
your plan now, not in December. The biggest thing too
is I would make sure to get like an extra
set of refills by the end of the year so
you just aren't stressed.
Speaker 3 (13:00):
Out that you need your medication.
Speaker 2 (13:04):
At that time. So let's talk about the insulin savings program.
Let's take a moment to remind everyone about the thirty
five dollars insulin Savings program. Regardless of what part deep
pan you have, what Medicare advantaged plan, you're on whether
you've hit your deductible. Your insulin cannot cost more than
(13:24):
thirty five dollars per month. If you're paying more, that's
a sign something needs to be reviewed. And with contract
terminations happening, this is a perfect time to double.
Speaker 3 (13:37):
Check your DRIG list.
Speaker 2 (13:40):
So how to appeal a denied claim or medication? When
contracts change, denials often spike because referrals and authorizations don't
transfer smoothly. So let's go quickly over that. On how
to find file on Medicare appeal. Get your explanation of benefits.
(14:02):
It will show you exactly why something was denied. Step
two follow the first level appeal. You do have sixty days,
but I would just do it as soon as possible.
Submit a written letter, a doctor support note, any clinical documentation. Naturally,
you can file an appeal by just calling the insurance company,
(14:24):
so that's the first option I would say. So if
it is denied again, you do it independent review. This
is handled by an outside medical reviewer and not your plan.
Speaker 3 (14:39):
And then es kalate if needed.
Speaker 2 (14:43):
You could appeal all the ways to all the way
to the Medicare Appeals Council. Many seniors simply when simply
because they took the time to fight it. If you're confused,
call someone experience. We walk clients through appeals all the time,
so please keep in mind on that as well. So
(15:05):
just kind of the state of everything, depending on you're
part of the world or nation, right, this has been
going on for quite some years now. Some some you
knowed uh, some plans are getting terminated not terminated, sorry.
(15:29):
Some insurance companies and medical groups are terming contracts right,
So it does happen across the nation. So what I
definitely suggest is that you read your mail. You make
sure that you're reading it correctly. There are sometimes where
(15:50):
maybe a specific subgroup of patients like a like a
group ppo plan or individual maybe under sixty five is
not included in the termination, so you also need to
look out for that to make sure. If you do
(16:11):
have relatives, friends, family, there is always you know, talk right.
Sometimes rumors are true and sometimes they are not true.
So talk to a reliable local source like your medical group,
(16:33):
your office, your doctor's office, the insurance company, and just
make sure all your ducks are lined up in a row.
Speaker 3 (16:44):
I know it is.
Speaker 2 (16:45):
Very inconvenient, especially if you are going through surgery or
post surgery to figure this out. That's why the continuation
of care is very important. To go over that within
insurance company and make sure that you got the documentation
and all that approved with them. Let's see, contract fights
(17:12):
between insurance companies and medical groups are just really becoming
more common and they create real stress for seniors. So today, please,
you have options, you do have rights, and you do
not have to navigate these changes alone. Whether you receive
(17:37):
determination letter or need to help reviewing your plan, or
want guidance or appeals or medication costs. My team at
Premiere three sixty are here to help. We do help
you and schedule your free Medicare review and we definitely
want to make sure you stay informed, empowered and stayed healthy.
(18:07):
Medicare rates actually have come out, so it would behove
me to actually go over it with you guys. Right, Okay,
so before we end, let me go over that because
I'm sure everyone is dying to know. So next week
I will go over it in more detail. But the
(18:28):
biggest thing is that your part by premium rate will
go up to two hundred two dollars and ninety cents.
That's up from one eighty five. So what is that
two two ninety minus one eighty five went up seventeen
(18:51):
dollars and ninety cents. I know COLA did go up
as well at two point six percent. Your part B
deductible is at two eighty three this year is at
two fifty seven. So those are those with a Medicare
supplement plan or a MEDIGAP plan that also has gone up.
(19:17):
What else is there? So of course if you have IRMA,
that has always also gone up as well.
Speaker 3 (19:26):
So the highest.
Speaker 2 (19:27):
Earn IRMA you will pay next year if you're in
the highest tax bracket, would be seven hundred eighty dollars
and ninety cents. So keep definitely keep this in mind. Okay,
(19:57):
I mean not a surprise that our premiums are going up, right,
It's just really not a surprise. But just overall, I
know many are very concerned with the stability of health
(20:20):
insurance and Medicare, but I don't think the government would
like upset seniors. So while rates may go up these
contract negotiations, my term you know, healthcare and your Medicare
(20:41):
is still here, different topic. I believe it is really broken.
But so the biggest takeaway I would say today too,
especially if you have an elderly parent.
Speaker 3 (20:57):
Or someone you are the caregiver to.
Speaker 2 (21:01):
Is that we do have a lot of sharp seniors
that are on top of this, but I am definitely
concerned with the seniors that don't read their nail don't
answer their phone. They might be in quite a shock
next year because if they do go to the doctor,
(21:22):
or you know, even if they didn't go to the
doctor and they went to the hospital, and it may
not be a network of course for emergencies, you could
go anywhere, it might be a shock. We are coming
up to December seventh, so we don't have much time,
but we definitely make it as easy and possible for
(21:43):
you to get the care you would like and maintain
a care that you've been receiving if that will help.
So please, if you are a caregiar or helping your
parents out, make sure you get all their ducks in
(22:09):
a row, meaning the best thing is to get all
their medication, all their doctors and specialists, including their dentists,
and letting your agent know if they have any other ailments,
(22:30):
chronic conditions, or if they have upcoming surgery or the
chronic conditions because that will help. And if they're on
Medicaid slash Medical in California, because that will definitely help
determine which plans, if any, they could go on. And unfortunately,
sometimes just even doctors themselves will terminate contracts, and it's
(22:55):
very unfortunate, especially if you're not in a metropolitan area,
that the pull of plans get smaller and smaller and
you really don't have much choices, which is very unfortunate.
But we are definitely here to guide you and all
that I know, this is probably not an uplifting episode.
(23:21):
It is very concerning that this is happening across a nation.
But as I mentioned, we're here to help you navigate
through this process to make sure that you are receiving
the level of care that you want and that you're
accustomed to along all these years. So please, if you
(23:49):
do need help with that, give us a call. We
will definitely help review your doctors, your medical group, advice
on appeals, medication cost. We're really here to help, so
schedule your free Medicare review. So this is Jennifer al
(24:10):
Fonso Flee and thank you for joining me on Medicare
three sixty show. Stay informed, stay empowered, and stay healthy.
Speaker 3 (24:19):
You have a great day.
Speaker 1 (24:23):
Thank you for joining the program Medicare three sixty. Hope
you found today's episode insightful and empowering. Remember, understanding your
Medicare options is key to making the right choices for
your health and financial well being. If you have questions
or topics you would like covered in future episodes of
Medicare three sixty, don't hesitate to reach out and speak
(24:46):
with our licensed insurance agent Until next time, Stay informed
and take charge of your healthcare journey. This has been
Medicare three sixty, your trusted source for all things Medicare.
Take care
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