Discover the 4 parts of Medicare, what they cover and how Insurance can be added to enhance that coverage.

Good morning! Welcome to the Medicare EZ as pie show. I am your host, Stephanie Garcia Hagen. I am the co-owner of Mesa Benefits, and we are your guide through the Medicare insurance process. I co-own our agency with my partner in life and in business, Bruce Hagen. Bruce, welcome to the show today.I thought that we would do something a little differently today. We spend a lot of time on the Medicare EZ as pie show talking about the importance of working with a local agent. Let’s talk today about a subject near and dear to my heart. I’m sure you are aware, but I am an insurance agent. Bruce and I make a living advising Medicare beneficiaries about their options for Medicare insurance. We have a few other feathers in our caps as well. We can help with final expense life insurance as well as indemnity insurance. I am licensed with the state of Colorado and a few others. Bruce and I are certified to sell insurance from a variety of insurance carriers. Which makes us insurance brokers. We can offer plans from different sources so that you can make the decision that fits your lifestyle, budget, and health situation.Bruce and I and our agency partners are insurance brokers. We are able like I said before, to find the fit that you need. Not the fit that we need. Let me make this distinction. An agent that works for one company and only one company can only sell plans from that company. Any good salesperson can tell you all the positive attributes of a plan. A broker can take your qualifications and find the plan that fits those parameters. The bias shifts when the focus of the advisor shifts. Let me give you an example. I sit down and have a meeting with you. You have done your research. You know what the general idea of each of the plans is, but you don’t necessarily know which one to pick. If I work for a single insurance company, I only can tell you the attributes of the plan that I represent. Because I am a broker, I can show you multiple options from whatever insurance company has plans available. The bias for a broker is simply that we would love to be your agent. We don’t have a preference on which plan you choose. If I were a captive agent selling for only one company, I would of course want to be your agent, but I also want to sell my company’s plan. There’s nothing wrong with someone working for one insurance company, you just need to know that is true when engaging in conversation with that agent. We make it very clear that we are brokers and have no preference on which plan you choose. Local agents are important not because of their geography, necessarily. The knowledge of the area and the plans that we have to choose from are imperative. You know me, I love a good example. So here goes. You call my phone and I answer. We go through the fact that all calls are recorded, I give you the disclaimer and we proceed to discuss specific plan information. You tell me that you see dr. So and so and we go through your medications. I look all these things up in the computer system and dr. So and so is in the network and your prescriptions are covered. You didn’t know that I don’t live in your area and the very important piece of the puzzle that is missing is that dr. So and so is leaving that practice and moving to one that doesn’t take the plan that I just signed you up on. The only way I would know that is because I live, work, and play right in your area. And dr. So and so is my aunt’s doctor too and I know that he is leaving for the sheer fact that I live right here. Now the second fold of my answer is this. If the agent that you are working with is in another state, it may be that the agent moved and still has a good understanding of the area. I think that situation would be a good one to be involved with. Let’s talk about those 800# ads on tv. I could rail about this subject. I cannot tell you how many people I have helped out of this situation. The 800#’s are on the tv to entice beneficiaries to call and enroll in plans. Are the people on the phone familiar with our area? Nope. Are the people on the phone employed by a single insurance company? Most likely. Is there anything wrong with that? Philosophically no. But practically yes. The thing that we get to help people out of is when there is an issue. Did you have to pay more at the dentist than you thought you were going to have to pay? Did you get a denial letter about a claim that your doctor submitted? If any of these things happen, who are you going to call? There is a phone number on the back of your insurance card that will get you to the customer service department at the insurance company. That may or may not work. If you have a local agent, you can call or go in to see that person who has lots of experience with situations just like the one you’re going through who may also be able to help you without you having to press 3 for this and 2 for that. These situations are what we are here for. And let’s talk about the fact that you get the opportunity to make changes to your policy in the 4th quarter of every year. And that’s whether you have a Medicare advantage plan or a stand-alone prescription drug plan. We make time for anyone that wants to go over things every year. Sometimes you need to make changes and sometimes you don’t but without a local agent, there is no one that is checking on that for you. And that’s because the obligation of the insurance company is to give you the annual notice of change. Not to go over it with you. The minute it goes in the mail, their obligation is met. If you need more than just to read a pamphlet, you need an agent.If you feel that you need a new agent, there are circumstances that will allow you to change agents. Most of the time it requires a plan change so that the new agent is writing you a new plan. This circumstance usually presents itself at the annual election period at the end of the year. You need a change both in plan and in agent and that can be easily accomplished for you. The rest of the year is a little tricky. An agent can answer your questions without being the agent of record on your policy, but there are some caveats. If you would like me to be your agent and don’t need or can’t do a policy change, we can work together by calling in to the insurance company together. I will not be able to talk to them on your behalf, though as I would if I were the agent of record. But, if you need help, I will help you. There is no doubt about that. And if and when the time is correct, I am happy to become your agent. I love what I do. Bruce loves what he does. We are here to help navigate this system. There are lots of twists and turns and we are your guide through the Medicare insurance process. If you know that you need an agent, give us a call. We can be reached at 970-549-0410. You can also reach us by searching the web at mesabenefits.com if we aren’t a good fit, we have lots of agency partners that you can talk to as well. Here on the Medicare EZ as pie show, we take the very complex Medicare insurance system and break it down for you into smaller and easier to digest slices of pie. Today, we are going to do a refresher course on the 4 types of Medicare.This is the Medicare EZ as pie show. I am your hostWelcome back to the Medicare EZ as pie show. I am your host, Stephanie Garcia-Hagen. We in the Medicare insurance world gear up every year for the annual election period. I said last week that my gear up used to start in September, but it has begun in July this year. June actually Medicare beneficiaries that are on Medicare advantage plans and prescription drug plans have an opportunity every year to change their plan. That time frame is from October 15th through December 7th. During those 8 weeks, beneficiaries have the opportunity to go over their plan’s changes and either stay right where they are or move plans. That change can be decided for whatever reason. Did the premium on your prescription drug plan go up? Did the Medicare advantage plan you are on change some of the copays or remove some of the extra benefits? Or has the network changed? We can help you determine if those changes necessitate a change for your plan. Taking time to check these policies every year could save you money for the next year to come. We are here to help. Please call our office to set up an appointment to get your policy reviewed. Our phone number is 970-549-0410 or you can find us at mesabenefits.com. If you fill out the contact form, we will call you. Let’s dig into today’s pie: What is Medicare?    •    Medicare is health insurance for people 65 or older. You’re first eligible to sign up for Medicare 3 months before you turn 65. You may be eligible to get Medicare earlier if you have a disability, end-stage renal disease (esrd), or als (also called Lou Gehrig’s disease).    •    How much does Medicare cost?    •    If you or a spouse has paid Medicare taxes while working for the required amount of time – customarily 10 years, you qualify for premium-free Medicare Part A. If you didn’t pay Medicare taxes for the required amount of time, you can buy it. There are 2 premium amounts and which one you pay depends on how long you or your spouse worked and paid Medicare taxes. The threshold for the difference in premium is more than or less than 30 quarters.    •    The Medicare Part B premium for 2022 is $170.10 (or more depending on your income) per month. This premium cost is evaluated yearly and can increase on that annual basis.    •    There is a penalty for late enrollment in Part B. You will pay 10% for every year that you could have signed up for Part B but didn’t.    •    The penalty is not a one-time late fee; you pay the penalty for as long as you have Part B.    •    The penalty will be added to your Part B premium and remember you may pay a higher premium based on your income.    •    Don’t fear – there are special circumstances where you or your spouse will not have to pay the penalty. It’s called a special enrollment period and most folks qualify for that special enrollment period by continuing to work and retain health coverage through either their or their spouse’s employer group plan.What are the parts of Medicare?At mesa benefits, we believe that Medicare is EZ as pie! We call the different parts of Medicare the slices of the pie. So… let’s take some time for 4 slices of the pie:    •    Slice of the pie #1: Part A (hospital insurance): helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care.    •    The first thing I think of is a hospital stay for a surgery – that’s covered by your Part A     •    If you need rehabilitative care after that surgery, your skilled nursing facility stay is covered by your Medicare Part A.    •    Hospice is Part A coverage.     •    We have an amazing hospice program here in grand junction through hope west. They help so many families through the end-of-life journey.    •    Home health care is also covered under Part A.     •    Folks that need extra help after a surgery, illness or injury are covered for home health care under Part A. That coverage is constantly evaluated for continued authorization through Medicare.    •    I want to make a distinction here. Home health care in Medicare is rehabilitative care. There is a strict time limit on Medicare covered home health care. That limit is 100 days. If your care extends past 100 days, it is considered long term care and Medicare does not cover long term care. This is one of the most common questions that we get at mesa benefits. We can help you determine long term care options but know going into your Medicare plan that it doesn’t cover long term care.    •    Slice of the pie #2: Part B (medical insurance): helps cover:    •    Services from doctors and other health care providers    •    Your primary care doctor.    •    Your cardiologist, your endocrinologist, your osteopath, your pulmonologist.     •    Your physical therapist    •    Outpatient care    •    Think of things like x-rays and lab work.    •    When your primary care doctor orders labs for your cholesterol check, it’s billed through Part B.    •    When your osteopath orders x-rays of the rib that they think is broken, this is covered under Part B.    •    Durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment)    •    Do you use a wheelchair or walker?    •    These items are covered under your Medicare Part B.     •    A doctor orders the equipment needed either as a new piece of equipment or a replacement and the durable medical equipment provider bills the cost to Medicare.     •    Typically, Medicare covers 80% of the cost and either the Medicare beneficiary or the insurance plan picks up the remaining 20% depending on the insurance chosen.    •    Many preventive services (like screenings, shots, or vaccines, and yearly “wellness” visits)    •    When you think preventative services, think routine    •    Mammogram    •    Prostate exam    •    Bone density scan    •    Colonoscopy    •    Many more    •    Shots and vaccines live in 2 parts of Medicare – Part B and Part D.  The type of shot or vaccine administered determines which part of Medicare pays and what type of cost share the beneficiary pays.     •    Slice of the pie #3: Medicare advantage (also known as Part C)    •    Medicare advantage is a Medicare-approved plan from a private company that offers an alternative to original Medicare for your health and drug coverage. These “bundled” plans include Part A, Part B, and usually Part D.    •    In most cases, you’ll need to use doctors who are in the plan’s network.    •    Plans are divided into 3 types.    •    HMO – health maintenance organization    •    All services are required from the network of providers.     •    Networks can be local, statewide, nationwide.    •    In order to have services paid, the provider must participate in the carrier’s network.    •    PPO – preferred provider organization    •    Cost share is less if services are provided from an in-network provider.    •    Out of network cost sharing is available.    •    The provider must agree to bill the carrier in out of network situations to have services paid.    •    Networks can be local, statewide, or nationwide.    •    And PFFS – private fee for service    •    PFFS plans often have premiums associated.    •    Each service in a PFFS plan must be agreed upon by the provide at time of service.    •    Costs for in and out of network services are often the same because each transaction must be agreed upon by the provider at the time of service.     •    Networks are fluid.    •    Plans may have lower out-of-pocket costs than original Medicare.    •    Taking all factors into account, Medicare advantage plans are a cost-effective option for medical coverage with Medicare.     •    Each plan offers unique features, benefits, copay, and co-insurance structures, and maximum out of pocket limits to keep the budgets of seniors in full focus.    •    Plans may offer some extra benefits that original Medicare doesn’t cover — like vision, hearing, and dental services. We talked about these coverages last week.    •    Vision screenings and correction are vital to health and well-being. Without vision correction through glasses or contacts, a person’s independence and self-reliance are threatened. If you can’t see, you can’t drive and being mobile is essential to independent living.    •    Hearing screenings are another essential part of medical coverage. Think of a time when you were in a situation where you couldn’t hear the entirety of a conversation. Did you feel left out of the group? Were you able to feel connected to friends or loved ones? How about if you only heard portions of what your doctor was saying during your examination, and you didn’t ask relevant questions of the doctor. Would your health be affected? Would you completely understand your care plan? Hearing loss contributes to depression and anxiety in seniors. Screenings and correction are a vital part of overall health.    •    Dental coverage is another “additional” benefit that is vital to overall health. I know you’ve heard that your oral health is the gateway to the health of the rest of the body. Keeping teeth clean and healthy helps prevent other diseases in the body. Missing teeth can lead to pain and also malnutrition. If a person can’t chew properly, they may choose less healthy alternatives that are easier to chew. If a person is missing teeth, they may also withdraw from social interactions because of embarrassment or insecurity.     •    Slice of the pie #4: Part D (drug coverage): helps cover the cost of prescription drugs (including many recommended shots or vaccines). You join a Medicare drug plan in addition to original Medicare, or you get it by joining a Medicare advantage plan with drug coverage. Plans that offer Medicare drug coverage are run by private insurance companies that follow rules set by Medicare.    •    Do you get a flu shot at the local pharmacy? That shot is covered by your Part D drug coverage.    •    Did you know that Medicare sets the rules for what medications are covered by your private insurance plan?     •    Did you also know that the 4 stages of drug coverage and their rules and limits are set by Medicare as well?We at mesa benefits believe that knowing what is covered under which type of Medicare is an important part of the education that we provide. If you as the beneficiary know what part of Medicare covers what procedure or service, you can make an informed decision about which type of Medicare insurance plan you want to use to access your Medicare parts. Whether that be a supplemental plan with a standalone prescription drug plan or a Medicare advantage plan that bundles your Medicare and the insurance. We hope that you have a better understanding of the parts of the Medicare pie. If you would like to go over your plan, please call Bruce or me at 970-549-0410 or check us out on the web at mesabenefits.com. There is a contact form that you can fill out and one of us will call you.When we come back, you are going to get to meet one of our agency partners. This is the Medicare EZ as pie show. I am your host. Stephanie Garcia-Hagen.

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