Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
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 sixty.
Speaker 2 (00:44):
Welcome to Medicare three sixty. I'm your host, Jennifer Lee,
and let's take in to Medicare new handbook on section
four Medicare Advantaged Plans and other options. So that is
on page sixty seven Medicare Savings Account Plan. Can I
(01:08):
get my healthcare from any doctor, other healthcare provider or hospital. Yes,
you could go to any Medicare proof doctor or other
healthcare provider or a hospital that agrees to treat you
and as an opt out of Medicare for Medicare Part
(01:30):
A and B Items and services MSA plans usually don't
have a network of doctors, other healthcare providers, or hospitals.
Do these plans cover prescription drugs No. If you join
a Medicare MSA plan and want Medicare drug coverage party,
(01:50):
you'll have to join a separate Medicare drug plan. Do
I need to choose a primary care doctor?
Speaker 3 (01:58):
No?
Speaker 2 (01:59):
Do I have to get a referral to use a specialist?
Speaker 3 (02:03):
No?
Speaker 2 (02:04):
What else do I need to know about this type
of plan? The plan deposits money into a special savings
account for you to use to pay health care expenses.
The amount of the deposit varies by plan. You could
use this money to pay for your Medicare covered costs
before you meet the deductible. Money left in your account
(02:27):
at the end of the year stays there.
Speaker 3 (02:31):
If you keep your.
Speaker 2 (02:32):
Plan for the following year, your plan will add any
deposits to the amount leftover. MSA plans don't charge a premium,
but you must continue to pay your Part B premiums.
The plan will also will only begin to cover your
Part A and B costs once you meet a high
yearly deductible, which varies by plan. Some plans may cover
(02:57):
some extra benefits like vision and dental services. You may
pay a premium for this extra coverage. Visit Medicare dot
gov or check with a plan for more information. So
these MSA plans, they're really not that popular. It's just
(03:17):
not popular. Although you know you can go to your
primary any primary care doctor specialists, there is a deductible
to meet, so it's really not that popular. Let's continue
to page sixty eight. Preferred Provider Organization PPO plan, so
(03:43):
people are very used to.
Speaker 3 (03:45):
This plan as well. A lot of group plans do.
Speaker 2 (03:49):
Have PPOs, So let's dive in. Can I get my
healthcare from any doctor or healthcare provider or hospital? PPO
plan have network doctors, specialists, hospitals, and other healthcare providers.
Speaker 3 (04:04):
You could use.
Speaker 2 (04:06):
You could also use out of network providers for covered services,
usually for a higher cost, if the provider agrees to
treat you and hasn't opted out of Medicare. For Medicare
Part A and B items and services, you're always covered
for emergency and urgent care. Okay, do these plans cover
(04:31):
prescription drugs?
Speaker 3 (04:33):
In most cases? Yes?
Speaker 2 (04:35):
If you're planning to enroll in a PPO and you
want Medicare drug coverage, Part dy, you must join a
PPO plan that offers Medicare coverage. If you join a
PPO plan without drug coverage, you can't join a separate
Medicare drug plan. So remember there are PPO plans that
(04:57):
may not have a drug plan. Right, We had spoken
about that before, that this plan may not have a
drug plan, But if it's a Medicare advantage plan, you
cannot get a separate drug plan, so notate that. So
(05:18):
I need to choose a primary care doctor.
Speaker 3 (05:21):
No.
Speaker 2 (05:22):
So sometimes some insurance companies do require a doctor to
be put on the ID card, but that doesn't necessarily
mean you have to stay or keep that doctor. I
don't know why they do it, but since it's a
Medicare advantage plan, they definitely have that sometimes so they do.
(05:48):
Don't think you are beholden to stay with that particular doctor.
Do I have to get a referral to use a
specialist in most case PCEs. No, but if you use
plan specialists in network, your cost for covered services will
usually be lower than if you use non plan specialists
(06:10):
out a network. What else do I need to know
about this type of plan? Because certain PPO providers are
preferred because you save money by using them. Medicare dot gov,
visit that or check with a plan for more information.
So a little bit more on PPOs, I would say,
(06:36):
see how it says in most cases know to get referral.
So yeah, definitely you could go in or at a network.
It gives you this flexibility to do that, which people
really like. But of course, depending on the covered service
I'm talking about, not like the doctors specialists, there might
(06:58):
be approvals needed, so like the skilled nursing facilities and
things of that nature. But of course, if you stay
in network, your costs will definitely be lower, which is
better for you versus going out of network. But then
this gives you the freedom. I would say, PPO plants
(07:22):
have higher maximum out of pockets, higher coinsurance copays, deductibles,
and sometimes a premium. Well depending on the plan, plants
could have a premium as well, So those are the things.
Sometimes what I've been noticing is some plans have lower
(07:46):
copays and max out of pockets then some, but their
network is not as big, not as robust, maybe just
regional base versus national where there's doctors all over the
United States. So keep things in mind. But sometimes those plans,
(08:10):
even though doctors specialists maybe add a network, it's still.
Speaker 3 (08:17):
Cost effective.
Speaker 2 (08:19):
So that's when you really do need to reach out
to a licensed independent agent that knows what they're doing
to help you on that like me, Okay, so let's
keep moving on to page sixty nine. Can I get
my healthcare from any doctor or other healthcare provider or hospital.
(08:42):
This is a private fee for service PFFS plans. You
could go to any Medicare proof doctor, other healthcare provider,
or hospital that accepts the plans payment terms, agrees to
treat you, and has an opt out of Medicare for
Medicare Part A and B items and services.
Speaker 3 (09:04):
If you join a private fee.
Speaker 2 (09:06):
For service plan that has a network, you could also
use any of the network providers who have agreed to
always treat plan members. If you choose an add a network, doctor, hospital,
or other provider who accepts the plans terms, you pay more.
(09:29):
Do these plans cover prescription drugs?
Speaker 3 (09:34):
Sometimes?
Speaker 2 (09:35):
If your PFS plan doesn't offer Medicare drug coverage, you
could join a Medicare drug plan to get Medicare drug
coverage Part B. Do I need to choose a primary
care doctor?
Speaker 3 (09:50):
No? Do I have to get.
Speaker 2 (09:52):
A referral to use a specialist. No, what else do
I need to know about this type of plan? The
plan decides how much you pay for services. Each year,
the plan will send the annual notice of change and
evidence of coverage with information about your cost sharing. SOMEFF
(10:16):
plans contract with a network of providers who agree to
always treat you, even if you never use them before.
Added network doctors, hospitals, and other providers may decide not
to treat you even if you use them before. In
a medical emergency, doctors, hospitals, and other providers must treat
(10:37):
you for each service you get. Make sure to show
your plan member cards to provide a provider before you
get treated. Visit Medicare doct or check with a plan
for more information. Okay, what can I say about PFFFEST plans?
(11:00):
I would say depending depending on your region, county, state,
these plans may be really popular or they may not
be popular. So tap for instance, California, these plans aren't
very popular. Let us go to page seventy. We're still
(11:22):
on Medicare Advantage plans and other options. We are going
to talk about Special Need Plan SNP.
Speaker 3 (11:31):
A S and.
Speaker 2 (11:32):
P provides benefits and services to provide with specific severe
and chronic diabetes, certain healthcare needs or who also have
Medicaid coverage.
Speaker 3 (11:45):
S and ps.
Speaker 2 (11:45):
Include care coordination services and tailor their benefits, provider choices,
and lists of drug formularies to best meet the specific
needs of the group they serve. Can I get my
healthcare from any doctor, other healthcare provider, or hospital. Some
(12:08):
SNPs cover services at a network and some don't. Check
with the plan to find out if they cover services
at a network. If so, how it affects your cost?
Do these plans cover prescription drugs? Yes, all SNPs provide
Medicare covered drug party.
Speaker 3 (12:30):
Do I need to choose a.
Speaker 2 (12:32):
Primary care doctor? Some ssmps require primary care doctors and
some don't. Check with a plan to find out if
you need to choose a primary care doctor. So on
the S and P plans, Do I need to choose
(12:54):
a primary care doctor? Some snp require primary care doctors
and some don't. Check with the plan to find out
if you need to choose a primary care doctor?
Speaker 3 (13:08):
Okay? Do I have to.
Speaker 2 (13:10):
Get a referral to use a specialist s Some SNPs
require referrals and some don't. Search and services like yearly
screening mammograms don't require referral. Check with a plan to
find out if you need a referral. What else do
I need to know about this type of plan? These
(13:31):
groups are eligible but not required to enroll in a
S and P plan, a SNIP plan actually sometimes we
call it. These groups are eligible but not required to
enroll in an essay in a SNIP dual eligible SNIP
D SNIP people who are eligible for both Medicare and Medicaid.
(13:53):
Dnips contract with your state Medicaid program to help coordinate
your Medicare and Medicate benefits. Some d snips may provide
Medicaid services in addition to Medicare services. Call your state
Medical Assistance Medicaid office to verify your Medicaid eligibility so
(14:17):
they're definitely I always want to make sure my clients
are on Medicaid slash medical in California, just never know
if things have changed. What they have been doing lately
is making sure the income is eligible. So sometimes you
(14:42):
do have to verify your income yearly to your Medicaid
office to keep your Medicaid eligibility. I've seen it where
clients didn't get it. We're on vacation, sent something in
but Medicaid did not receive it, so they will lose
(15:04):
their Medicaid coverages, right, and most some depending on your state,
like California, if you are on full dual eligible Medicaid
medical they even pay for your Part B premium.
Speaker 3 (15:22):
So if that's the case, that's.
Speaker 2 (15:26):
The biggest one, and then obviously all other costs or
drug costs that might be substantial, you definitely want to
make sure. Of course, sometimes when you are full dual,
you don't need a yearly attestation or requirement to provide
income because based on your Social Security they already know
(15:47):
how much income you're making.
Speaker 3 (15:50):
Believe me, they.
Speaker 2 (15:52):
Know that, right, because every single year Medicare Social Security
will look to your back on your income and charge
you more for your Medicare part premium. If you made
a certain amount and there are tears, let us know
and we can help you with that too, Okay. Chronic
(16:15):
conditions snip CE snip people who have specific severe or
disabling chronic conditions like diabetes and stage renal disease SRD, HIV, AIDS,
chronic health failure, or dementia. Plans may further limit membership
(16:36):
to a single chronic condition or group of related chronic conditions,
So let us talk about that. There are definitely a
lot of plans out there. Some are particular to diabetes,
some have diabetes and heart condition on their renal disease
ESRDS on their chronic heart failure mental health. So these
(17:04):
are some of the.
Speaker 3 (17:05):
Type of chronic condition plans.
Speaker 2 (17:07):
So chronic condition plans, you could definitely switch on these plans.
But more to come on that. So not all plants
are created equal. Your area, your counting may have a
lot of chronic condition plans to choose from, they may not. Also,
(17:29):
sometimes a chronic conditioned plan also needs to be like
a Medicaid plan because if you look at the coverages,
it's quite high and Medicaid might help you cover that.
So just things to look at these chronic snip plans
see snip plans. They definitely provide better coverage, more benefits,
(17:54):
maybe even lower drug costs. Something worth to look at
if you do have a chronic condition. But like I said,
some plans are not created equal, so it's really good
to review what you have and these plans as well. Okay,
(18:16):
Institutional snip SNP I snips. People who live in ceartain
conditions like nursing homes or who live in community but
require a high level of nursing care at home. So
I SNIP plans definitely are like you know, those skilled
nursing facilities residential care facilities require high level nursing care home.
(18:38):
So if that's the case, you can possibly be on
the plan. But sometimes you've got to review. Compare might
not be the best or just not really a very
good plan. They're very more limited, I would say, in
different geo geographic areas, right, So definitely could look at that.
(19:06):
So new If you have Medicare and get full Medicaid benefits,
you could join or switch an integrated decent once a
calendar month.
Speaker 3 (19:14):
For more information, go to Medicare.
Speaker 2 (19:17):
Dot gov slash special dash enrollment dash periods and select
I have Medicare and get full Medicaid benefits. When you're
ready to find and compare snips in your area, visit
Medicare dot gov slash pan dot dash Compare. Of course,
you could always reach out to us. You can filter
your search results by special needs plans. Caution to the wary,
(19:43):
Like I said, plans are not all created equal. You
don't want to be on a plan that you are
going to actually pay more. I have less coverage, so
keep that in consideration.
Speaker 3 (19:58):
When looking at these type of plans.
Speaker 2 (20:04):
I need more that I do. Want to talk about
this definitely. If you are on a chronic plan or
have chronic conditions, or on medical, Medicaid or institutional, it's
worth looking at to make sure you're on the right plan.
As mentioned, if you are on Medicaid medical, there are
(20:29):
specific plans that are like coded that have full Medicaid benefits,
and those plans you can change once a month. I
don't know if you want to do that, but sometimes
people do make a mistake or a bad choice or
just didn't know you're able to do that.
Speaker 3 (20:49):
Chronic condition plans too.
Speaker 2 (20:51):
If you are not on a chronic condition plan and
want to be on a chronic condition plan because you qualify,
you could definitely move to that once a year. Something
that I've seen very unethical agents do is move a
client to a chronic conditioned plan a c sniff knowing
(21:13):
that they don't have a chronic condition, because that's like
a special enrollment period. And what happens if they can't
verify your condition or you don't have that condition, you
actually open up a special enrollment period where you go
back to a regular plan. So those are unscrupulous, unethical
(21:35):
agents that I would not want to deal with because
that's just wrong. That's falsifying something that's not true, right,
So I think that's that for that. There are definitely
(21:56):
different options you could join, switch, drop, make changes to
your Medicare advantage plan. Remember you must have both parts
A and B to join a Medicare advantage plan during
these times. So there is an initial enrollment period, the
general enrollment period, Open enrollment period. I kind of want
(22:24):
to go over this, but we're kind of running out
of time too. There is also the Medicare Advantage Open
Enrollment Period, Special Enrollment Period, five Star Special Enrollment Period.
So there's just a lot of enrollment periods. I would
love to go over it now, but let's save that
(22:44):
topic for next time. I would just really be cautious
of agents that call you right out of the blue
without your permission, because technically they are not supposed to
call you, even if you do put something on Facebook
or an ad on a commercial or online and they
(23:10):
do have a right to call you. Just don't let
an agent push you guilty you do anything you don't
want to do without due diligence. A great agent is
not going to pressure you to do anything you're not
comfortable with. Do to your due diligence. Before you do
switch and change plans, talk to someone that's reputable, ethical
(23:35):
and has been doing this for quite a while, because
I'm telling you you do not want your plan, or
your healthcare or your coverage to be something you didn't want,
get penalized and so forth.
Speaker 3 (23:51):
A little bit of a down here.
Speaker 2 (23:53):
But let to us just end with that. Of course,
there's wonderful Medicare agents as well that.
Speaker 3 (24:03):
You will come across.
Speaker 2 (24:05):
I do meet clients that are very happy with their agents.
Speaker 3 (24:08):
So great that.
Speaker 2 (24:09):
Means we still have a job and we're doing our
job right. So I would say, till next time, do
you have any questions, concerns, issues, don't hesitate to give
us a ring. So I'm signing off Jennifer Lee, Medicare
three sixty hosts, I will talk to you Sam, Bye bye.
Speaker 1 (24:33):
Thank you for joining the program Medicare at 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 cover it in future
episodes of Medicare three sixty, don't hesitate to reach out
(24:56):
and speak with our licensed insurance agents until next time.
Stay informed and take charge of your healthcare journey. This
has been Medicare three point 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 sixty.
Speaker 2 (00:44):
Welcome to Medicare three sixty. I'm your host, Jennifer Lee,
and let's take in to Medicare new handbook on section
four Medicare Advantaged Plans and other options. So that is
on page sixty seven Medicare Savings Account Plan. Can I
(01:08):
get my healthcare from any doctor, other healthcare provider or hospital. Yes,
you could go to any Medicare proof doctor or other
healthcare provider or a hospital that agrees to treat you
and as an opt out of Medicare for Medicare Part
(01:30):
A and B Items and services MSA plans usually don't
have a network of doctors, other healthcare providers, or hospitals.
Do these plans cover prescription drugs No. If you join
a Medicare MSA plan and want Medicare drug coverage party,
(01:50):
you'll have to join a separate Medicare drug plan. Do
I need to choose a primary care doctor?
Speaker 3 (01:58):
No?
Speaker 2 (01:59):
Do I have to get a referral to use a specialist?
Speaker 3 (02:03):
No?
Speaker 2 (02:04):
What else do I need to know about this type
of plan? The plan deposits money into a special savings
account for you to use to pay health care expenses.
The amount of the deposit varies by plan. You could
use this money to pay for your Medicare covered costs
before you meet the deductible. Money left in your account
(02:27):
at the end of the year stays there.
Speaker 3 (02:31):
If you keep your.
Speaker 2 (02:32):
Plan for the following year, your plan will add any
deposits to the amount leftover. MSA plans don't charge a premium,
but you must continue to pay your Part B premiums.
The plan will also will only begin to cover your
Part A and B costs once you meet a high
yearly deductible, which varies by plan. Some plans may cover
(02:57):
some extra benefits like vision and dental services. You may
pay a premium for this extra coverage. Visit Medicare dot
gov or check with a plan for more information. So
these MSA plans, they're really not that popular. It's just
(03:17):
not popular. Although you know you can go to your
primary any primary care doctor specialists, there is a deductible
to meet, so it's really not that popular. Let's continue
to page sixty eight. Preferred Provider Organization PPO plan, so
(03:43):
people are very used to.
Speaker 3 (03:45):
This plan as well. A lot of group plans do.
Speaker 2 (03:49):
Have PPOs, So let's dive in. Can I get my
healthcare from any doctor or healthcare provider or hospital? PPO
plan have network doctors, specialists, hospitals, and other healthcare providers.
Speaker 3 (04:04):
You could use.
Speaker 2 (04:06):
You could also use out of network providers for covered services,
usually for a higher cost, if the provider agrees to
treat you and hasn't opted out of Medicare. For Medicare
Part A and B items and services, you're always covered
for emergency and urgent care. Okay, do these plans cover
(04:31):
prescription drugs?
Speaker 3 (04:33):
In most cases? Yes?
Speaker 2 (04:35):
If you're planning to enroll in a PPO and you
want Medicare drug coverage, Part dy, you must join a
PPO plan that offers Medicare coverage. If you join a
PPO plan without drug coverage, you can't join a separate
Medicare drug plan. So remember there are PPO plans that
(04:57):
may not have a drug plan. Right, We had spoken
about that before, that this plan may not have a
drug plan, But if it's a Medicare advantage plan, you
cannot get a separate drug plan, so notate that. So
(05:18):
I need to choose a primary care doctor.
Speaker 3 (05:21):
No.
Speaker 2 (05:22):
So sometimes some insurance companies do require a doctor to
be put on the ID card, but that doesn't necessarily
mean you have to stay or keep that doctor. I
don't know why they do it, but since it's a
Medicare advantage plan, they definitely have that sometimes so they do.
(05:48):
Don't think you are beholden to stay with that particular doctor.
Do I have to get a referral to use a
specialist in most case PCEs. No, but if you use
plan specialists in network, your cost for covered services will
usually be lower than if you use non plan specialists
(06:10):
out a network. What else do I need to know
about this type of plan? Because certain PPO providers are
preferred because you save money by using them. Medicare dot gov,
visit that or check with a plan for more information.
So a little bit more on PPOs, I would say,
(06:36):
see how it says in most cases know to get referral.
So yeah, definitely you could go in or at a network.
It gives you this flexibility to do that, which people
really like. But of course, depending on the covered service
I'm talking about, not like the doctors specialists, there might
(06:58):
be approvals needed, so like the skilled nursing facilities and
things of that nature. But of course, if you stay
in network, your costs will definitely be lower, which is
better for you versus going out of network. But then
this gives you the freedom. I would say, PPO plants
(07:22):
have higher maximum out of pockets, higher coinsurance copays, deductibles,
and sometimes a premium. Well depending on the plan, plants
could have a premium as well, So those are the things.
Sometimes what I've been noticing is some plans have lower
(07:46):
copays and max out of pockets then some, but their
network is not as big, not as robust, maybe just
regional base versus national where there's doctors all over the
United States. So keep things in mind. But sometimes those plans,
(08:10):
even though doctors specialists maybe add a network, it's still.
Speaker 3 (08:17):
Cost effective.
Speaker 2 (08:19):
So that's when you really do need to reach out
to a licensed independent agent that knows what they're doing
to help you on that like me, Okay, so let's
keep moving on to page sixty nine. Can I get
my healthcare from any doctor or other healthcare provider or hospital.
(08:42):
This is a private fee for service PFFS plans. You
could go to any Medicare proof doctor, other healthcare provider,
or hospital that accepts the plans payment terms, agrees to
treat you, and has an opt out of Medicare for
Medicare Part A and B items and services.
Speaker 3 (09:04):
If you join a private fee.
Speaker 2 (09:06):
For service plan that has a network, you could also
use any of the network providers who have agreed to
always treat plan members. If you choose an add a network, doctor, hospital,
or other provider who accepts the plans terms, you pay more.
(09:29):
Do these plans cover prescription drugs?
Speaker 3 (09:34):
Sometimes?
Speaker 2 (09:35):
If your PFS plan doesn't offer Medicare drug coverage, you
could join a Medicare drug plan to get Medicare drug
coverage Part B. Do I need to choose a primary
care doctor?
Speaker 3 (09:50):
No? Do I have to get.
Speaker 2 (09:52):
A referral to use a specialist. No, what else do
I need to know about this type of plan? The
plan decides how much you pay for services. Each year,
the plan will send the annual notice of change and
evidence of coverage with information about your cost sharing. SOMEFF
(10:16):
plans contract with a network of providers who agree to
always treat you, even if you never use them before.
Added network doctors, hospitals, and other providers may decide not
to treat you even if you use them before. In
a medical emergency, doctors, hospitals, and other providers must treat
(10:37):
you for each service you get. Make sure to show
your plan member cards to provide a provider before you
get treated. Visit Medicare doct or check with a plan
for more information. Okay, what can I say about PFFFEST plans?
(11:00):
I would say depending depending on your region, county, state,
these plans may be really popular or they may not
be popular. So tap for instance, California, these plans aren't
very popular. Let us go to page seventy. We're still
(11:22):
on Medicare Advantage plans and other options. We are going
to talk about Special Need Plan SNP.
Speaker 3 (11:31):
A S and.
Speaker 2 (11:32):
P provides benefits and services to provide with specific severe
and chronic diabetes, certain healthcare needs or who also have
Medicaid coverage.
Speaker 3 (11:45):
S and ps.
Speaker 2 (11:45):
Include care coordination services and tailor their benefits, provider choices,
and lists of drug formularies to best meet the specific
needs of the group they serve. Can I get my
healthcare from any doctor, other healthcare provider, or hospital. Some
(12:08):
SNPs cover services at a network and some don't. Check
with the plan to find out if they cover services
at a network. If so, how it affects your cost?
Do these plans cover prescription drugs? Yes, all SNPs provide
Medicare covered drug party.
Speaker 3 (12:30):
Do I need to choose a.
Speaker 2 (12:32):
Primary care doctor? Some ssmps require primary care doctors and
some don't. Check with a plan to find out if
you need to choose a primary care doctor. So on
the S and P plans, Do I need to choose
(12:54):
a primary care doctor? Some snp require primary care doctors
and some don't. Check with the plan to find out
if you need to choose a primary care doctor?
Speaker 3 (13:08):
Okay? Do I have to.
Speaker 2 (13:10):
Get a referral to use a specialist s Some SNPs
require referrals and some don't. Search and services like yearly
screening mammograms don't require referral. Check with a plan to
find out if you need a referral. What else do
I need to know about this type of plan? These
(13:31):
groups are eligible but not required to enroll in a
S and P plan, a SNIP plan actually sometimes we
call it. These groups are eligible but not required to
enroll in an essay in a SNIP dual eligible SNIP
D SNIP people who are eligible for both Medicare and Medicaid.
(13:53):
Dnips contract with your state Medicaid program to help coordinate
your Medicare and Medicate benefits. Some d snips may provide
Medicaid services in addition to Medicare services. Call your state
Medical Assistance Medicaid office to verify your Medicaid eligibility so
(14:17):
they're definitely I always want to make sure my clients
are on Medicaid slash medical in California, just never know
if things have changed. What they have been doing lately
is making sure the income is eligible. So sometimes you
(14:42):
do have to verify your income yearly to your Medicaid
office to keep your Medicaid eligibility. I've seen it where
clients didn't get it. We're on vacation, sent something in
but Medicaid did not receive it, so they will lose
(15:04):
their Medicaid coverages, right, and most some depending on your state,
like California, if you are on full dual eligible Medicaid
medical they even pay for your Part B premium.
Speaker 3 (15:22):
So if that's the case, that's.
Speaker 2 (15:26):
The biggest one, and then obviously all other costs or
drug costs that might be substantial, you definitely want to
make sure. Of course, sometimes when you are full dual,
you don't need a yearly attestation or requirement to provide
income because based on your Social Security they already know
(15:47):
how much income you're making.
Speaker 3 (15:50):
Believe me, they.
Speaker 2 (15:52):
Know that, right, because every single year Medicare Social Security
will look to your back on your income and charge
you more for your Medicare part premium. If you made
a certain amount and there are tears, let us know
and we can help you with that too, Okay. Chronic
(16:15):
conditions snip CE snip people who have specific severe or
disabling chronic conditions like diabetes and stage renal disease SRD, HIV, AIDS,
chronic health failure, or dementia. Plans may further limit membership
(16:36):
to a single chronic condition or group of related chronic conditions,
So let us talk about that. There are definitely a
lot of plans out there. Some are particular to diabetes,
some have diabetes and heart condition on their renal disease
ESRDS on their chronic heart failure mental health. So these
(17:04):
are some of the.
Speaker 3 (17:05):
Type of chronic condition plans.
Speaker 2 (17:07):
So chronic condition plans, you could definitely switch on these plans.
But more to come on that. So not all plants
are created equal. Your area, your counting may have a
lot of chronic condition plans to choose from, they may not. Also,
(17:29):
sometimes a chronic conditioned plan also needs to be like
a Medicaid plan because if you look at the coverages,
it's quite high and Medicaid might help you cover that.
So just things to look at these chronic snip plans
see snip plans. They definitely provide better coverage, more benefits,
(17:54):
maybe even lower drug costs. Something worth to look at
if you do have a chronic condition. But like I said,
some plans are not created equal, so it's really good
to review what you have and these plans as well. Okay,
(18:16):
Institutional snip SNP I snips. People who live in ceartain
conditions like nursing homes or who live in community but
require a high level of nursing care at home. So
I SNIP plans definitely are like you know, those skilled
nursing facilities residential care facilities require high level nursing care home.
(18:38):
So if that's the case, you can possibly be on
the plan. But sometimes you've got to review. Compare might
not be the best or just not really a very
good plan. They're very more limited, I would say, in
different geo geographic areas, right, So definitely could look at that.
(19:06):
So new If you have Medicare and get full Medicaid benefits,
you could join or switch an integrated decent once a
calendar month.
Speaker 3 (19:14):
For more information, go to Medicare.
Speaker 2 (19:17):
Dot gov slash special dash enrollment dash periods and select
I have Medicare and get full Medicaid benefits. When you're
ready to find and compare snips in your area, visit
Medicare dot gov slash pan dot dash Compare. Of course,
you could always reach out to us. You can filter
your search results by special needs plans. Caution to the wary,
(19:43):
Like I said, plans are not all created equal. You
don't want to be on a plan that you are
going to actually pay more. I have less coverage, so
keep that in consideration.
Speaker 3 (19:58):
When looking at these type of plans.
Speaker 2 (20:04):
I need more that I do. Want to talk about
this definitely. If you are on a chronic plan or
have chronic conditions, or on medical, Medicaid or institutional, it's
worth looking at to make sure you're on the right plan.
As mentioned, if you are on Medicaid medical, there are
(20:29):
specific plans that are like coded that have full Medicaid benefits,
and those plans you can change once a month. I
don't know if you want to do that, but sometimes
people do make a mistake or a bad choice or
just didn't know you're able to do that.
Speaker 3 (20:49):
Chronic condition plans too.
Speaker 2 (20:51):
If you are not on a chronic condition plan and
want to be on a chronic condition plan because you qualify,
you could definitely move to that once a year. Something
that I've seen very unethical agents do is move a
client to a chronic conditioned plan a c sniff knowing
(21:13):
that they don't have a chronic condition, because that's like
a special enrollment period. And what happens if they can't
verify your condition or you don't have that condition, you
actually open up a special enrollment period where you go
back to a regular plan. So those are unscrupulous, unethical
(21:35):
agents that I would not want to deal with because
that's just wrong. That's falsifying something that's not true, right,
So I think that's that for that. There are definitely
(21:56):
different options you could join, switch, drop, make changes to
your Medicare advantage plan. Remember you must have both parts
A and B to join a Medicare advantage plan during
these times. So there is an initial enrollment period, the
general enrollment period, Open enrollment period. I kind of want
(22:24):
to go over this, but we're kind of running out
of time too. There is also the Medicare Advantage Open
Enrollment Period, Special Enrollment Period, five Star Special Enrollment Period.
So there's just a lot of enrollment periods. I would
love to go over it now, but let's save that
(22:44):
topic for next time. I would just really be cautious
of agents that call you right out of the blue
without your permission, because technically they are not supposed to
call you, even if you do put something on Facebook
or an ad on a commercial or online and they
(23:10):
do have a right to call you. Just don't let
an agent push you guilty you do anything you don't
want to do without due diligence. A great agent is
not going to pressure you to do anything you're not
comfortable with. Do to your due diligence. Before you do
switch and change plans, talk to someone that's reputable, ethical
(23:35):
and has been doing this for quite a while, because
I'm telling you you do not want your plan, or
your healthcare or your coverage to be something you didn't want,
get penalized and so forth.
Speaker 3 (23:51):
A little bit of a down here.
Speaker 2 (23:53):
But let to us just end with that. Of course,
there's wonderful Medicare agents as well that.
Speaker 3 (24:03):
You will come across.
Speaker 2 (24:05):
I do meet clients that are very happy with their agents.
Speaker 3 (24:08):
So great that.
Speaker 2 (24:09):
Means we still have a job and we're doing our
job right. So I would say, till next time, do
you have any questions, concerns, issues, don't hesitate to give
us a ring. So I'm signing off Jennifer Lee, Medicare
three sixty hosts, I will talk to you Sam, Bye bye.
Speaker 1 (24:33):
Thank you for joining the program Medicare at 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 cover it in future
episodes of Medicare three sixty, don't hesitate to reach out
(24:56):
and speak with our licensed insurance agents until next time.
Stay informed and take charge of your healthcare journey. This
has been Medicare three point sixty, your trusted source for
all things Medicare Take care
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