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
(00:22):
are 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.
Speaker 2 (00:40):
Sixty Welcome to Medicare three sixty show. I'm your host,
Jennifer Lee, and today we are continuing our journey on
the Medicare ANDU Handbook. So we are at page seventy one,
(01:01):
Section four Medicare Advantage Plan and other options you could join,
switch drop, or make changes share Medicare Advantage Plan. Remember
you must have both Part A and R B to
join a Sorry it's not A or B. It is
(01:22):
just both Part A and Part B to join a
Medicare advantage plan during these times, so keep in mind
that Part A and B Part A if you or
your spouse work for more than forty quarters, which is
(01:43):
equivalent to ten years. This is eultiple at zero costs
and Part B depending on your income.
Speaker 3 (01:51):
Depends on that.
Speaker 2 (01:53):
But there are times that I do see clients would
just Part B and not Part A, and definitely those
are one offs. But we could help you get Part
A and.
Speaker 3 (02:04):
See if you could get a plan.
Speaker 2 (02:07):
Let's go to initial enrollment period go to page seventeen
when you first become eligible for Medicare. When you first
become eligible for Medicare, you could join a Medicare advantage
plan with or without drugs coverage. If you joined a
(02:27):
Medicare advantage plan during your initial rollment period, you could
switch to another Medicare advantage plan, whether without coverage, or
go back to original Medicare, whether without separate Medicare plan
within the first three months.
Speaker 3 (02:43):
You have Medicare.
Speaker 2 (02:46):
So let's just say you're totally unhappy, you can go
back to original Medicare within the first three months. Okay,
General enrollment period go to page eighteen January first from
March thirty first. If you have Part A coverage and
you get Part B for the first time.
Speaker 3 (03:07):
During this period.
Speaker 2 (03:09):
You could also join a Medicare advantage plant with or
without drug coverage. You'll have two months after adding Part.
Speaker 3 (03:20):
B to join a plan.
Speaker 2 (03:23):
Your coverage starts the first day of the month after
you sign up, so let's read that again. If you
have Part A coverage and you get Part B for
the first time during this period, you could also join
a event a Medicare advantage plan with or without coverage.
You have two months after adding Part B to join
(03:44):
in a plan.
Speaker 4 (03:45):
Okay, open enrollment period October fifteenth to December seventh, you
could join, switch, or drop a Medicare advantage plan with
or without drug coverage during the open enrollment period each year.
Speaker 3 (04:01):
Your coverage starts.
Speaker 2 (04:02):
On January first, as long as the plan gets your
enrollment requests by December seventh. If you join a Medicare
advantage plan during this period but change your mind, you
can switch back to original Medicare or change to a
different Medicare advantage plan, depending on which.
Speaker 3 (04:19):
Coverage works best better for you.
Speaker 2 (04:21):
During the Medicare Advantage open enrollment period January first to
March thirty first described on the next page. So this
is either the happy time or the dreaded time.
Speaker 3 (04:34):
Where you're getting a million.
Speaker 2 (04:36):
Phone calls which is technically not allowed, or you're getting
tons of mail.
Speaker 3 (04:43):
Which could happen.
Speaker 2 (04:46):
Usually it's private inform at public information or emails. Right,
So this is the big, big time where you're seeing
a million of commercials on Medicare actually even year round,
from October fifteenth to December seventh. To have a coverage
start January first. Medicare Advantage Open enrollment period January first
(05:14):
to March thirty first. You could only switch plans once
during this period. Coverage starts the first of the month
after the plan gets your request. If you're in a
Medicare Advantage plan whither without drug coverage, during this period,
you can switch to another Medicare advantage plan, whether without
drug coverage, drop your Medicare plan and return to original Medicare.
(05:39):
You'll also be able to join a separate Medicare drug
plan during this period. You can't switch from original Medicare
to a Medicare advantage plan, join a separate Medicare drug
plan if you have original Medicare, switch from one Medicare
drug plan to another. If you have original Medicare, you
(06:00):
can only make one change during this period, and any
changes you make will be effective the first of the
month after the plan.
Speaker 3 (06:09):
Gets your request.
Speaker 2 (06:10):
If you're returning to original Medicare enjoying a separate drug plan,
you don't need to contact your Medicare advantage plan to
dist enrolled. Then disenrollment will happen automatically when you join
the drunk plan. Okay, a tongue tie today.
Speaker 3 (06:26):
Okay, I want to read that again.
Speaker 2 (06:28):
So, if you're on a Medicare advantage plan, you can't
switch to another Medicare advantage plan.
Speaker 3 (06:36):
You can definitely go to.
Speaker 2 (06:39):
Original Medicare as well, but the biggest thing is you
can't go to an a Medicare advantage plan. If you're
on original Medicare, you can't join a separate drug plan.
If you have Original Medicare, you can't switch from one
drug plan to the other.
Speaker 3 (06:57):
So that's why it is.
Speaker 2 (06:59):
Definitely important to go over your options from October fifteenth
to December seventh for a jan first effective date. If
you can't and those don't apply to you, what else
can I say about this? A lot of people don't
(07:20):
think they could change. They weren't aware of this type
of change. Compliantly, an agent cannot reach out to you
and ask you to change. It's just one of those
things where you know you could make a change and
you could reach out to an agent at that time,
so keep that in mind. Special enrollment period go to
(07:42):
page seventeen.
Speaker 3 (07:44):
Qualifying life event.
Speaker 2 (07:46):
In most cases, if you join a Medicare advantaged plan,
you must keep it for the calendar year starting the
date your coverage begins. Okay, in most cases, if you
join a Medicared vantage plan, you must keep it for
the calendar year starting the date your coverage begins. However,
(08:10):
in searchain situations like you move or you lose other
insurance coverage, you may be able to join, switch, or
drop a Medicare advantished plan during special enrollment period.
Speaker 3 (08:21):
Go to page eighty.
Speaker 2 (08:23):
So special enrollment periods are typically let's just say you
have Part A, you get on Part B, and you
do this because you're leaving a group work plan, so
that is caused for a special enrollment period. Other enrollment
(08:45):
periods maybe that you're moving to a different county or state.
Speaker 3 (08:52):
Another special role.
Speaker 2 (08:53):
Period is like the FEMA ones. If there's like a flood, range, tornado,
five things of that nature.
Speaker 3 (09:05):
That was declared a FEMA event, then.
Speaker 2 (09:11):
Insurance companies typically say, Okay, you weren't able to make
a choice because of all this disastrous things that happen
in the world. You are able to use an enrollment period,
a special one because you weren't able to make that change. Okay,
so five star special enrollment period December eighth November thirtieth
(09:35):
the following year. No, you could only sourch plans once
during this period, okay. Medicare uses ratings from one to
five stars help you compare plans based on quality and performance.
If a Medicare Advantage plan, Medicare Drug plan, or Medicare
cost plan with a far five star quality rating is
(09:56):
available in your area, you could use the five star
special enrollment period to switch from your current Medicare plan
to a Medicare plan with a five star Hall Fame rating.
Visit Medicare dot go for more information. So just remember
if your area or area coverage or county has a
(10:19):
five star rated Medicare plan, okay, you are able to
switch one time for that. So that's pretty neat if
you want to be on a plan that has that
live star rating. So important if you drop your Medicare
(10:41):
supplement insurance MEDICAP policy to join a Medicare advantage plan,
you may not get the same policy back. Okay, if
you drop your Medicare supplement insurance MEDICAP policy to join
a Medicare advantage plan, you may not get the same
(11:02):
policy back. Also, if you want to return to original
Medicare and don't drop your Medicare advantage plan within twelve
months of joining the Medicare advantage plan, you may be
limited in your ability to get a Medicapp policy when
you return to original Medicare.
Speaker 3 (11:18):
Got a page seventy eight.
Speaker 2 (11:20):
In general, when you join a Medicare advantage plan, you
must keep the plan for the rest of the year
unless you drop it to return to original Medicare within
twelve months of joining the Medicare advantage plan. You could
drop or change Medicare advantage plans during the open enrollment
period or Medicare Advantage Open enrollment period, or if you
qualify for a special enrollment period.
Speaker 3 (11:43):
Okay, this is a diazy. This is a lot.
Speaker 2 (11:47):
Basically, it was just saying that let's just say you're
on a supplemental plan, then you join a Medicare advantage plan.
Technically you can't go back to that plan without any underwriting, right,
so if you have illnesses, you may not be able
(12:09):
to get that plan. However, if you do drop it
in return back to original Medicare within the twelve months
of joining that Medicare advantage plan, you will be able
to without the underwriting. So this is when it gets
tricky because a Medicare supplemental plan does require underwriting, but
(12:31):
within the first six months of joining Medicare there is
no underwriting for that. And of course there's different special
underwriting specials that we could discuss at a future time.
This could get a little bit tricky. That's why talk
(12:52):
to your licensed insurance agent that knows what they're doing. Hey,
it does Medicare off for other types of plans or
programs to get health coverage? Yes, Medicare may offer some
other plans and programs in your area. Some provide both
Part A hospital insurance and Part B medical insurance coverage,
(13:15):
while others provide only Part B coverage. Some also provide
Medicare drug coverage Part B. They have some, but not all,
of the same rules as Medicare advantage plans. However, each
has special rules and exceptions, so you should contact any
plans you're interested in to get more details. Medicare cost plans.
(13:36):
Medicare cost plans are a type of Medicare health plan
available in certain limited areas of the country.
Speaker 3 (13:43):
In general, you could join even if you only have
Part B.
Speaker 2 (13:47):
If you have Part A and or B and go
to a non network provider regional Medicare covers a service,
you'll pay the Part A and Part B co insurance
and adaptibles. You could join any time the Medicare cost
plan accepting you members could leave anytime and return to
original Medicare. You could join a separate Medicare drug plan,
(14:10):
or you could get Medicare drug coverage Part D from
the Medicare cost plan if offered.
Speaker 3 (14:16):
You could choose to get a.
Speaker 2 (14:18):
Separate Medicare drug plan even if the Medicare cost plan
offers Medicare drug coverage could only add or drug coverage
at certain times. Pages eighty to eighty one. Go to
medicare dot gov slash plan dash Compare to find out
if there are Medicare cost plans in your area. You
(14:38):
can contact the plan you're interested in from more information.
Your state Health insurance Assistant program ship can also help you.
Go to pages one fourteen to one seventeen for the
phone number of your local ship. A trusted agent or
broker may also be able to help Medicare cost plans.
(14:58):
I don't see these are around in my area, so
they are limited depending on your regional area. Program of
All Inclusive Care for the Elderly PACE PACE is a
Medicare and Medicaid program offered in many states that allow
(15:19):
people who otherwise need a nursing home level of care
to remain in the community like a home, apartment, or
other appropriate setting.
Speaker 3 (15:29):
To qualify for PACE.
Speaker 2 (15:32):
You must meet these conditions. You're fifty five or older,
you live in the service area of a PACE organization.
You're certified buyer state as needing a nursing home level
of care at the time you join.
Speaker 3 (15:48):
You're able to live.
Speaker 2 (15:50):
Safely in the community with the help of PACE services.
PACE covers all Medicare and Medicaid covered care and services
and other services that the PACE team of healthcare professionals
decides are necessary to improve and maintain.
Speaker 3 (16:05):
Your health and wellness.
Speaker 2 (16:07):
This includes drugs, as well as any other medically necessary
care like doctor a healthcare provider visits, transportation, home care,
hospital visits, and even nursing home stays when necessary. If
you have Medicaid, you won't have to pay a monthly
premium for the long term care portion of the PACEE benefit.
(16:29):
If you have Medicaid, you won't have to pay a
monthly premium for the long term care portion of the
PACE benefit. If you have Medicare but not Medicaid, you'll
be charged monthly to cover the long term care portion
of the PACE benefit in a premium for Medicare Drug
Coverage Part D. However, in PACE, there's never a deductible
or co payment for any drug service or care that
(16:50):
the PACE team of healthcare professionals approves. Visit Medicare dot
gov slash Pace to find out there's a PACE organization
that serves your community. So I say, these are pretty
good programs. Have visited some PACE places and they are
(17:10):
pretty new and nice. It's really intended.
Speaker 3 (17:15):
For those that.
Speaker 2 (17:18):
We want to keep up the home right instead of
going to that skilled nursing facility. So this allows the
senior to go to this place, have lunch, maybe dinner, snacks,
do activities, celebrate different holidays and so forth, have a
(17:39):
community of other seniors, and also have the healthcare there
like I've seen ones where there's the clinic, there the
physical therapy, dietitian, they even like style your hair, do
your nails. So a lot of that that I'm seniors
(18:00):
that aren't as active or don't have a lot of friends,
family visit, or however can be with a community. I say,
as you are growing older, a community is very important
to stave off mental illness or loneliness that can actually
(18:23):
make people quite sick just being alone and not having
any interactions with others. So PACE programs are definitely great
in my opinion. Of course, not every PACE organization are
the same, so maybe better organized and other have better
(18:45):
activities or just have a better sense of level of care.
But it is a great concept, very nice for those
people that need that sense of community, want to stay
at home, don't want to go to skilled nursing, so
PACE definitely does take care of them. Medicare Innovation Medicare
(19:08):
develops innovation models, demonstrations, and pilot initiatives to test and
measure the effect of potential changes in medicare. These initiatives
help bind new ways to connect you to value based care,
which focuses on better quality of care, provider performance, and
your patient experience. These initiatives may also include lower costs
(19:31):
and may offer you extra benefits and services. They operate
only for limited time and for a specific group of people,
and or offered only specific areas. Examples of current and
future models, demonstrations, and pilot initiatives include innovations in dementia,
primary care care related to specific procedures like hip and
(19:52):
knee replacement care, cancer care, skilled nursing, facility care or
rehabilitation care, and care for people with chronic kidney disease
and stage renal disease ESRD. Medicare also explores innogations through
accountable care organizations acos. Ask your doctor if they participate
(20:13):
in these models, demonstrations and pilot programs what it means
for your care. To learn more about the current Medicare
models and demonstrations and pilot initiatives, call one eight hundred
Medicare one hundred and sixty three three four to two seven.
Go to pages ten to fourteen for an overview of
your Medicare options. So I don't see this a lot,
(20:36):
but definitely talk to your doctors if they participate in
this type of innovation. Well, so we're actually more than
halfway done through our journey on this Medicare and New Handbook.
We are going to talk about section five on page
(21:01):
seventy five Medicare Supplement Insurance MEDAGAP. I don't want to
start on this quite yet since we don't have enough time.
About three and a half minutes left. So what's on
your mind? What's the state? I would say a lot
(21:23):
of seniors are concerned based on the current administration on
what's going to happen to Medicare. There are maybe cuts
to Medicare and so forth. But I'm just the type that, yes,
(21:47):
we need to be proactive in regards to the updates,
but also not worry about what's to come if it
hasn't come yet. Right, I am hearing that Medicaid in
medical in California they may bring back the income limits.
(22:11):
So let me touch upon that. So a couple years ago,
not being precise, but there was an asset limit in
regards to if a person were eligible for medical which
is Medicaid outside of California, and if you did have
(22:33):
a certain amount of threshold assets then you did not qualify.
Then they changed it to if you have one hundred
thousand or less in assets, then you will qualify for
Medicaid medical. And then they eliminated the assets portions of
(22:54):
the Medicaid qualifications.
Speaker 3 (22:57):
So what does that mean.
Speaker 2 (23:00):
That meant if you had zero income or less income,
you're lower than the property level.
Speaker 3 (23:08):
Of that year.
Speaker 2 (23:11):
Even if you had a million dollars in the bank,
you were still eligible to qualify for Medicaid medical. Medicaid
medical has a lot of great benefits such as premiums
being paid, co pays, co insurance, literally nothing, drugs costing
(23:36):
you very little covered drugs.
Speaker 3 (23:39):
Or nothing at all.
Speaker 2 (23:41):
So it could have been a benefit of people in
that space. However, I'm hearing maybe twenty twenty six that
asset limits are going to come back, so definitely keep
that in mind. Definitely Medicare is here to stay, but
(24:04):
with budget cuts and different things, we will just wait
and see what will happen. In regards to that. I
do advocate for fraud, waste, and abuse because we shouldn't
(24:25):
be wasting tax dollars on fivrillist things or things that
don't make sense, but we shouldn't take away so much
for the deep benefit of our seniors. Until next time,
my name is Jennifer Lee. Your hosts at Medicare three sixty.
(24:46):
I look forward to seeing you again next week. Take care,
bye bye.
Speaker 1 (24:53):
Thank you for joining the program Medicare at three sixty.
I hope you found today's episode insightful 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
(25:16):
speak 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
(00:22):
are 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.
Speaker 2 (00:40):
Sixty Welcome to Medicare three sixty show. I'm your host,
Jennifer Lee, and today we are continuing our journey on
the Medicare ANDU Handbook. So we are at page seventy one,
(01:01):
Section four Medicare Advantage Plan and other options you could join,
switch drop, or make changes share Medicare Advantage Plan. Remember
you must have both Part A and R B to
join a Sorry it's not A or B. It is
(01:22):
just both Part A and Part B to join a
Medicare advantage plan during these times, so keep in mind
that Part A and B Part A if you or
your spouse work for more than forty quarters, which is
(01:43):
equivalent to ten years. This is eultiple at zero costs
and Part B depending on your income.
Speaker 3 (01:51):
Depends on that.
Speaker 2 (01:53):
But there are times that I do see clients would
just Part B and not Part A, and definitely those
are one offs. But we could help you get Part
A and.
Speaker 3 (02:04):
See if you could get a plan.
Speaker 2 (02:07):
Let's go to initial enrollment period go to page seventeen
when you first become eligible for Medicare. When you first
become eligible for Medicare, you could join a Medicare advantage
plan with or without drugs coverage. If you joined a
(02:27):
Medicare advantage plan during your initial rollment period, you could
switch to another Medicare advantage plan, whether without coverage, or
go back to original Medicare, whether without separate Medicare plan
within the first three months.
Speaker 3 (02:43):
You have Medicare.
Speaker 2 (02:46):
So let's just say you're totally unhappy, you can go
back to original Medicare within the first three months. Okay,
General enrollment period go to page eighteen January first from
March thirty first. If you have Part A coverage and
you get Part B for the first time.
Speaker 3 (03:07):
During this period.
Speaker 2 (03:09):
You could also join a Medicare advantage plant with or
without drug coverage. You'll have two months after adding Part.
Speaker 3 (03:20):
B to join a plan.
Speaker 2 (03:23):
Your coverage starts the first day of the month after
you sign up, so let's read that again. If you
have Part A coverage and you get Part B for
the first time during this period, you could also join
a event a Medicare advantage plan with or without coverage.
You have two months after adding Part B to join
(03:44):
in a plan.
Speaker 4 (03:45):
Okay, open enrollment period October fifteenth to December seventh, you
could join, switch, or drop a Medicare advantage plan with
or without drug coverage during the open enrollment period each year.
Speaker 3 (04:01):
Your coverage starts.
Speaker 2 (04:02):
On January first, as long as the plan gets your
enrollment requests by December seventh. If you join a Medicare
advantage plan during this period but change your mind, you
can switch back to original Medicare or change to a
different Medicare advantage plan, depending on which.
Speaker 3 (04:19):
Coverage works best better for you.
Speaker 2 (04:21):
During the Medicare Advantage open enrollment period January first to
March thirty first described on the next page. So this
is either the happy time or the dreaded time.
Speaker 3 (04:34):
Where you're getting a million.
Speaker 2 (04:36):
Phone calls which is technically not allowed, or you're getting
tons of mail.
Speaker 3 (04:43):
Which could happen.
Speaker 2 (04:46):
Usually it's private inform at public information or emails. Right,
So this is the big, big time where you're seeing
a million of commercials on Medicare actually even year round,
from October fifteenth to December seventh. To have a coverage
start January first. Medicare Advantage Open enrollment period January first
(05:14):
to March thirty first. You could only switch plans once
during this period. Coverage starts the first of the month
after the plan gets your request. If you're in a
Medicare Advantage plan whither without drug coverage, during this period,
you can switch to another Medicare advantage plan, whether without
drug coverage, drop your Medicare plan and return to original Medicare.
(05:39):
You'll also be able to join a separate Medicare drug
plan during this period. You can't switch from original Medicare
to a Medicare advantage plan, join a separate Medicare drug
plan if you have original Medicare, switch from one Medicare
drug plan to another. If you have original Medicare, you
(06:00):
can only make one change during this period, and any
changes you make will be effective the first of the
month after the plan.
Speaker 3 (06:09):
Gets your request.
Speaker 2 (06:10):
If you're returning to original Medicare enjoying a separate drug plan,
you don't need to contact your Medicare advantage plan to
dist enrolled. Then disenrollment will happen automatically when you join
the drunk plan. Okay, a tongue tie today.
Speaker 3 (06:26):
Okay, I want to read that again.
Speaker 2 (06:28):
So, if you're on a Medicare advantage plan, you can't
switch to another Medicare advantage plan.
Speaker 3 (06:36):
You can definitely go to.
Speaker 2 (06:39):
Original Medicare as well, but the biggest thing is you
can't go to an a Medicare advantage plan. If you're
on original Medicare, you can't join a separate drug plan.
If you have Original Medicare, you can't switch from one
drug plan to the other.
Speaker 3 (06:57):
So that's why it is.
Speaker 2 (06:59):
Definitely important to go over your options from October fifteenth
to December seventh for a jan first effective date. If
you can't and those don't apply to you, what else
can I say about this? A lot of people don't
(07:20):
think they could change. They weren't aware of this type
of change. Compliantly, an agent cannot reach out to you
and ask you to change. It's just one of those
things where you know you could make a change and
you could reach out to an agent at that time,
so keep that in mind. Special enrollment period go to
(07:42):
page seventeen.
Speaker 3 (07:44):
Qualifying life event.
Speaker 2 (07:46):
In most cases, if you join a Medicare advantaged plan,
you must keep it for the calendar year starting the
date your coverage begins. Okay, in most cases, if you
join a Medicared vantage plan, you must keep it for
the calendar year starting the date your coverage begins. However,
(08:10):
in searchain situations like you move or you lose other
insurance coverage, you may be able to join, switch, or
drop a Medicare advantished plan during special enrollment period.
Speaker 3 (08:21):
Go to page eighty.
Speaker 2 (08:23):
So special enrollment periods are typically let's just say you
have Part A, you get on Part B, and you
do this because you're leaving a group work plan, so
that is caused for a special enrollment period. Other enrollment
(08:45):
periods maybe that you're moving to a different county or state.
Speaker 3 (08:52):
Another special role.
Speaker 2 (08:53):
Period is like the FEMA ones. If there's like a flood, range, tornado,
five things of that nature.
Speaker 3 (09:05):
That was declared a FEMA event, then.
Speaker 2 (09:11):
Insurance companies typically say, Okay, you weren't able to make
a choice because of all this disastrous things that happen
in the world. You are able to use an enrollment period,
a special one because you weren't able to make that change. Okay,
so five star special enrollment period December eighth November thirtieth
(09:35):
the following year. No, you could only sourch plans once
during this period, okay. Medicare uses ratings from one to
five stars help you compare plans based on quality and performance.
If a Medicare Advantage plan, Medicare Drug plan, or Medicare
cost plan with a far five star quality rating is
(09:56):
available in your area, you could use the five star
special enrollment period to switch from your current Medicare plan
to a Medicare plan with a five star Hall Fame rating.
Visit Medicare dot go for more information. So just remember
if your area or area coverage or county has a
(10:19):
five star rated Medicare plan, okay, you are able to
switch one time for that. So that's pretty neat if
you want to be on a plan that has that
live star rating. So important if you drop your Medicare
(10:41):
supplement insurance MEDICAP policy to join a Medicare advantage plan,
you may not get the same policy back. Okay, if
you drop your Medicare supplement insurance MEDICAP policy to join
a Medicare advantage plan, you may not get the same
(11:02):
policy back. Also, if you want to return to original
Medicare and don't drop your Medicare advantage plan within twelve
months of joining the Medicare advantage plan, you may be
limited in your ability to get a Medicapp policy when
you return to original Medicare.
Speaker 3 (11:18):
Got a page seventy eight.
Speaker 2 (11:20):
In general, when you join a Medicare advantage plan, you
must keep the plan for the rest of the year
unless you drop it to return to original Medicare within
twelve months of joining the Medicare advantage plan. You could
drop or change Medicare advantage plans during the open enrollment
period or Medicare Advantage Open enrollment period, or if you
qualify for a special enrollment period.
Speaker 3 (11:43):
Okay, this is a diazy. This is a lot.
Speaker 2 (11:47):
Basically, it was just saying that let's just say you're
on a supplemental plan, then you join a Medicare advantage plan.
Technically you can't go back to that plan without any underwriting, right,
so if you have illnesses, you may not be able
(12:09):
to get that plan. However, if you do drop it
in return back to original Medicare within the twelve months
of joining that Medicare advantage plan, you will be able
to without the underwriting. So this is when it gets
tricky because a Medicare supplemental plan does require underwriting, but
(12:31):
within the first six months of joining Medicare there is
no underwriting for that. And of course there's different special
underwriting specials that we could discuss at a future time.
This could get a little bit tricky. That's why talk
(12:52):
to your licensed insurance agent that knows what they're doing. Hey,
it does Medicare off for other types of plans or
programs to get health coverage? Yes, Medicare may offer some
other plans and programs in your area. Some provide both
Part A hospital insurance and Part B medical insurance coverage,
(13:15):
while others provide only Part B coverage. Some also provide
Medicare drug coverage Part B. They have some, but not all,
of the same rules as Medicare advantage plans. However, each
has special rules and exceptions, so you should contact any
plans you're interested in to get more details. Medicare cost plans.
(13:36):
Medicare cost plans are a type of Medicare health plan
available in certain limited areas of the country.
Speaker 3 (13:43):
In general, you could join even if you only have
Part B.
Speaker 2 (13:47):
If you have Part A and or B and go
to a non network provider regional Medicare covers a service,
you'll pay the Part A and Part B co insurance
and adaptibles. You could join any time the Medicare cost
plan accepting you members could leave anytime and return to
original Medicare. You could join a separate Medicare drug plan,
(14:10):
or you could get Medicare drug coverage Part D from
the Medicare cost plan if offered.
Speaker 3 (14:16):
You could choose to get a.
Speaker 2 (14:18):
Separate Medicare drug plan even if the Medicare cost plan
offers Medicare drug coverage could only add or drug coverage
at certain times. Pages eighty to eighty one. Go to
medicare dot gov slash plan dash Compare to find out
if there are Medicare cost plans in your area. You
(14:38):
can contact the plan you're interested in from more information.
Your state Health insurance Assistant program ship can also help you.
Go to pages one fourteen to one seventeen for the
phone number of your local ship. A trusted agent or
broker may also be able to help Medicare cost plans.
(14:58):
I don't see these are around in my area, so
they are limited depending on your regional area. Program of
All Inclusive Care for the Elderly PACE PACE is a
Medicare and Medicaid program offered in many states that allow
(15:19):
people who otherwise need a nursing home level of care
to remain in the community like a home, apartment, or
other appropriate setting.
Speaker 3 (15:29):
To qualify for PACE.
Speaker 2 (15:32):
You must meet these conditions. You're fifty five or older,
you live in the service area of a PACE organization.
You're certified buyer state as needing a nursing home level
of care at the time you join.
Speaker 3 (15:48):
You're able to live.
Speaker 2 (15:50):
Safely in the community with the help of PACE services.
PACE covers all Medicare and Medicaid covered care and services
and other services that the PACE team of healthcare professionals
decides are necessary to improve and maintain.
Speaker 3 (16:05):
Your health and wellness.
Speaker 2 (16:07):
This includes drugs, as well as any other medically necessary
care like doctor a healthcare provider visits, transportation, home care,
hospital visits, and even nursing home stays when necessary. If
you have Medicaid, you won't have to pay a monthly
premium for the long term care portion of the PACEE benefit.
(16:29):
If you have Medicaid, you won't have to pay a
monthly premium for the long term care portion of the
PACE benefit. If you have Medicare but not Medicaid, you'll
be charged monthly to cover the long term care portion
of the PACE benefit in a premium for Medicare Drug
Coverage Part D. However, in PACE, there's never a deductible
or co payment for any drug service or care that
(16:50):
the PACE team of healthcare professionals approves. Visit Medicare dot
gov slash Pace to find out there's a PACE organization
that serves your community. So I say, these are pretty
good programs. Have visited some PACE places and they are
(17:10):
pretty new and nice. It's really intended.
Speaker 3 (17:15):
For those that.
Speaker 2 (17:18):
We want to keep up the home right instead of
going to that skilled nursing facility. So this allows the
senior to go to this place, have lunch, maybe dinner, snacks,
do activities, celebrate different holidays and so forth, have a
(17:39):
community of other seniors, and also have the healthcare there
like I've seen ones where there's the clinic, there the
physical therapy, dietitian, they even like style your hair, do
your nails. So a lot of that that I'm seniors
(18:00):
that aren't as active or don't have a lot of friends,
family visit, or however can be with a community. I say,
as you are growing older, a community is very important
to stave off mental illness or loneliness that can actually
(18:23):
make people quite sick just being alone and not having
any interactions with others. So PACE programs are definitely great
in my opinion. Of course, not every PACE organization are
the same, so maybe better organized and other have better
(18:45):
activities or just have a better sense of level of care.
But it is a great concept, very nice for those
people that need that sense of community, want to stay
at home, don't want to go to skilled nursing, so
PACE definitely does take care of them. Medicare Innovation Medicare
(19:08):
develops innovation models, demonstrations, and pilot initiatives to test and
measure the effect of potential changes in medicare. These initiatives
help bind new ways to connect you to value based care,
which focuses on better quality of care, provider performance, and
your patient experience. These initiatives may also include lower costs
(19:31):
and may offer you extra benefits and services. They operate
only for limited time and for a specific group of people,
and or offered only specific areas. Examples of current and
future models, demonstrations, and pilot initiatives include innovations in dementia,
primary care care related to specific procedures like hip and
(19:52):
knee replacement care, cancer care, skilled nursing, facility care or
rehabilitation care, and care for people with chronic kidney disease
and stage renal disease ESRD. Medicare also explores innogations through
accountable care organizations acos. Ask your doctor if they participate
(20:13):
in these models, demonstrations and pilot programs what it means
for your care. To learn more about the current Medicare
models and demonstrations and pilot initiatives, call one eight hundred
Medicare one hundred and sixty three three four to two seven.
Go to pages ten to fourteen for an overview of
your Medicare options. So I don't see this a lot,
(20:36):
but definitely talk to your doctors if they participate in
this type of innovation. Well, so we're actually more than
halfway done through our journey on this Medicare and New Handbook.
We are going to talk about section five on page
(21:01):
seventy five Medicare Supplement Insurance MEDAGAP. I don't want to
start on this quite yet since we don't have enough time.
About three and a half minutes left. So what's on
your mind? What's the state? I would say a lot
(21:23):
of seniors are concerned based on the current administration on
what's going to happen to Medicare. There are maybe cuts
to Medicare and so forth. But I'm just the type that, yes,
(21:47):
we need to be proactive in regards to the updates,
but also not worry about what's to come if it
hasn't come yet. Right, I am hearing that Medicaid in
medical in California they may bring back the income limits.
(22:11):
So let me touch upon that. So a couple years ago,
not being precise, but there was an asset limit in
regards to if a person were eligible for medical which
is Medicaid outside of California, and if you did have
(22:33):
a certain amount of threshold assets then you did not qualify.
Then they changed it to if you have one hundred
thousand or less in assets, then you will qualify for
Medicaid medical. And then they eliminated the assets portions of
(22:54):
the Medicaid qualifications.
Speaker 3 (22:57):
So what does that mean.
Speaker 2 (23:00):
That meant if you had zero income or less income,
you're lower than the property level.
Speaker 3 (23:08):
Of that year.
Speaker 2 (23:11):
Even if you had a million dollars in the bank,
you were still eligible to qualify for Medicaid medical. Medicaid
medical has a lot of great benefits such as premiums
being paid, co pays, co insurance, literally nothing, drugs costing
(23:36):
you very little covered drugs.
Speaker 3 (23:39):
Or nothing at all.
Speaker 2 (23:41):
So it could have been a benefit of people in
that space. However, I'm hearing maybe twenty twenty six that
asset limits are going to come back, so definitely keep
that in mind. Definitely Medicare is here to stay, but
(24:04):
with budget cuts and different things, we will just wait
and see what will happen. In regards to that. I
do advocate for fraud, waste, and abuse because we shouldn't
(24:25):
be wasting tax dollars on fivrillist things or things that
don't make sense, but we shouldn't take away so much
for the deep benefit of our seniors. Until next time,
my name is Jennifer Lee. Your hosts at Medicare three sixty.
(24:46):
I look forward to seeing you again next week. Take care,
bye bye.
Speaker 1 (24:53):
Thank you for joining the program Medicare at three sixty.
I hope you found today's episode insightful 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
(25:16):
speak 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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