Welcome to Season 3, Episode 28 of "Winning Isn't Easy"! 🎙️
In this informative episode, we're delving into a crucial topic: "Medicare 101 and Open Enrollment Information." Join your host, Nancy L. Cavey, a seasoned expert in disability law, as she provides valuable insights and guidance on understanding the basics of Medicare and navigating the open enrollment process with our special guest Hunter Walton who helps people with their Medicare decisions and policies!
We'll cover:
🏥 An overview of Medicare and its different parts.
🗓️ The importance of the Medicare open enrollment period.
🔍 How to make informed decisions during open enrollment to ensure you have the right coverage for your healthcare needs.
Whether you're approaching Medicare age or helping a loved one with their healthcare decisions, this episode equips you with essential knowledge to make informed choices regarding Medicare coverage.
Tune in to Season 3, Episode 28 of "Winning Isn't Easy" for an insightful exploration of Medicare 101 and valuable information on open enrollment. 📻🩺
Please remember that the information shared is based on general knowledge and should not replace personalized advice from a qualified healthcare professional or Medicare specialist.
Welcome to Season 3, Episode 28 of "Winning Isn't Easy"! 🎙️
In this informative episode, we're delving into a crucial topic: "Medicare 101 and Open Enrollment Information." Join your host, Nancy L. Cavey, a seasoned expert in disability law, as she provides valuable insights and guidance on understanding the basics of Medicare and navigating the open enrollment process with our special guest Hunter Walton who helps people with their Medicare decisions and policies!
We'll cover:
🏥 An overview of Medicare and its different parts.
🗓️ The importance of the Medicare open enrollment period.
🔍 How to make informed decisions during open enrollment to ensure you have the right coverage for your healthcare needs.
Whether you're approaching Medicare age or helping a loved one with their healthcare decisions, this episode equips you with essential knowledge to make informed choices regarding Medicare coverage.
Tune in to Season 3, Episode 28 of "Winning Isn't Easy" for an insightful exploration of Medicare 101 and valuable information on open enrollment. 📻🩺
Please remember that the information shared is based on general knowledge and should not replace personalized advice from a qualified healthcare professional or Medicare specialist.
Hey, I am Nancy Cavey . Welcome to this week's episode of Winning Isn't Easy. We're going to take a little twist this , uh, episode. I'm not gonna be discussing legal issues. I'm gonna be discussing something that's near and dear to my client's , uh, hearts. And that is continued medical care. Many disability carriers require that a person continues to get medical care , uh, as a condition of getting their disability benefits. And of course, many disability carriers also require that you apply for Social Security disability benefits. Uh, and part of the benefit of getting Social Security disability benefits is Medicare or Medicaid. I handle, as you know, both ERISA disability, individual disability and Social Security disability cases. And our special guest this week is our dear friend Hunter Walton. And Hunter helps us with our clients, helping them get , uh, Medicare or Medicaid coverage , uh, when they lose that coverage as a result of their disability. So before we get started and talk with Hunter, we're gonna take a quick break. Welcome back, hunter. Would you introduce yourself and tell us about you and how you got into this profession?
Speaker 2:Yes, ma'am. Thank you so much for having me on today. Like, like you said, my name is Hunter Walton. I am , I am a resident down here in Florida, near to Miss Nancy's office. And I do a lot of things within the community, but my main job is I'm a independent health insurance agent.
Speaker 1:And so how did you become an independent health insurance agent and why healthcare as opposed to anything else?
Speaker 2:It's a good question. So really, I kind of feel like my life has come full circle. So whenever I was growing up, I was constantly out in the community with my dad and he did a big not-for-profit organization up in Tennessee. And he had me with him a lot of times over into , um, golf tournaments, going out and raising money. And then with the, with the money that we raised, we went out and we were able to help people in need throughout the community. We'd get phone calls and people who've lost their houses during floods or a lot of different reasons that people end up unforeseen, reasons that they did not expect and needed extra help. So we were always trying to be there for them, helping people in need. And that was kind of the big reasons I moved down here to get into this business, is I knew that I could do this and also be able to incorporate that into my business and help people here in the community and then also loop in health insurance, help save money so that these things that are unforeseen, you have, you have these funds to help back you to those hard times.
Speaker 1:You are a fantastic community resource. Uh, and as I've said, we refer our clients to you for assistance. So tell me what's new, if anything, with Medicare, and how do you think that's going to impact a person's ability , uh, to get Medicare or make the right decision about what they need?
Speaker 2:A few new things that I've seen so far this year is they are restricting some of the commercials that you see on tv. Some of the advertising they do, A lot of it ended up being kind of misleading and leading people into thinking that they could qualify for certain things just to basically get their phone call enrolled them into , into something that's really not gonna help them when it comes to their, their health. So they're limiting those commercials and advertisements, really putting some restrictive measures into effect. That's one of the big things I've seen. Uh , the other big thing, which I won't go on , it's not not too exciting. People like here in the , the percentages as much, but for the drug coverage, they're getting rid of the catastrophic coverage phase that's more related to the, the drugs. So hopefully that'll save some people some money. I know once people hit the , what they call the donut hole, the gap coverage, it gets very expensive. So the phase after that, they're, they're cutting that off. So that ,
Speaker 1:So could you , could you explain to people what that donut hole is? Uh, and, and literally, I , I want everybody who's listening to this, imagine in their mind a donut . So you've got the donut and you've got a hole and you're gonna come out the other side. So tell us about the impact of a donut hole in the context of Medicare coverage.
Speaker 2:Okay. So with, with your drug coverage, you pay your copays leading up to the certain amount that they, so this number changes just about every year, but so you had your copays, so that's the money you're paying. And then the insurance company also pays toward that drug every single time you get it. So it all goes to the, the pharmaceutical companies. So once the money that you've spent and the insurance company have spent together and it reaches this gap, then you start paying a much higher percentage. And it can get very expensive people. I know doctors don't like it as much. 'cause a lot of times when people hit that number, they can't afford it anymore, so they stop taking their medications. So it's been going back and forth over the years and trying to figure out a way to, to cut this out completely. But they still haven't, still haven't really come down to it. But, so
Speaker 1:For this year , what's, what's the number That's sort of the , the, the , the top of the bottom of the donut hole, if you will. So we're, we're gonna work our way through that first part of the donut. What's that level before we get to the hole ?
Speaker 2:It's around $4,700 . I can't remember the exact number off the top of my head, but once,
Speaker 1:So go ahead . So, so then, then we get through that 4,700. Where do we start again? Uh, with the, the more equitable reimbursement , uh, or formulas.
Speaker 2:So it's after, it's about $3,000 more after that, that, and during that phase, you're paying 25% of that prescription cost. It's around 7,000. I don't have the exact number right in front of me. It's send the seven thousands. So there's a, there's a nice little donut hole where all of a sudden your , your prices jump up tremendously compared to your copays.
Speaker 1:So Hunter, I, I get to the first part of the donut and then I'm in the hole when I'm paying 25% of it. And I get to that $7,000 number approximately after that. I , I , is there a , a another , uh, ceiling that we have to be concerned about? Or, or is it , is that reimbursement formula remain the same as it was before?
Speaker 2:So they're , that's where they're gonna get rid of that catastrophic coverage phase. So once you get over the hump, then the insurance company is gonna be responsible for it at that point. So your cost will be cut out and it's around 5% before where people were paying about 5% or the $4 something for the copay after the donut hole was over with. So after you make it through the donut hole, then you're gonna jump out on the other side and the insurance company is gonna cover it.
Speaker 1:Okay . So advertising donut hole in terms of , uh, catastrophic , um, uh, drug reimbursement. Anything else new on the horizon for , uh, Medicare
Speaker 2:In a whole? Not so much. Another big thing to consider is just market share companies coming in and out of the market and making things more competitive, bringing you more benefits, things like that. You should always be on the lookout for the , at the end of every year. And as we get closer and closer to annual enrollment.
Speaker 1:So , um, what are the kinds of things that people should be looking for during this , uh, enrollment period, and what is it that you do to help people , uh, find the right coverage and make the right decision for their personal and unique , uh, circumstances?
Speaker 2:So I would always say check. Make sure your doctors are still in network. They come in and out of different networks all the time. Um , with, with the negotiations between doctors groups and insurance companies, the formularies, your prescription drugs, they go up and down on the tier levels, copays go up. So that's always something to look out for as you go into the new season. Double checked . Go
Speaker 1:Ahead . Go ahead . And so when, when you're there trying to help someone exactly what is it that you do and how do you help them make the right decision?
Speaker 2:So I , I'm a independent health insurance agent, so I've contracted with several companies. So the way that I come in is I'm able to take your prescriptions, your doctors, your financial needs, networks, a lot of different things, a lot of different factors, and put it into a system and it populates different plans. That way we can look to see which plans have your doctors, which one's gonna save you, your, your pharmaceutical costs , your drug costs, and help you decide which way to go. When it comes to the cost on your price, are you wanting to pay for a large group of, of a network or are you okay with , uh, a smaller network to where you can save some more money?
Speaker 1:So if you were helping me to find a policy that would be appropriate for me, what are the kinds of pieces of information that you would wanna know to, I guess, plug into this program that would help you get the right answer for me?
Speaker 2:Big question I would ask. First thing I'd start off with is, are you planning on moving and traveling a whole bunch? If that's the case, then there's certain plans that are focused more on having those nationwide networks. And if it's something that you're planning on staying local, then there's local plans where it can, it can save you money.
Speaker 1:Well then obviously you wanna know what their prescriptions are. Correct?
Speaker 2:Correct. And so prescriptions plan a huge part of it. They, every single company has a different formulary, they all have different funding and they can determine where they wanna put it. So they have certain plans that help with the heart problems, breathing issues, things along those lines. Every company is different. So doctors and network number one , pharmaceuticals number two. And then what you're looking at for like your financial for how much you want to pay for copays and max out of pockets , things like that.
Speaker 1:So it's gonna be location, your medical condition , uh, the type of doctor that you're seeing , the type of prescriptions that you're getting, and then what you're able to afford. Would those be like five factors or pieces of information that you're considering in trying to make a recommendation?
Speaker 2:Yes, ma'am. There's, there's a few other things, but they're all, unfortunately, there's no plan that fits all, is all based off of individuals and what they need for their, their healthcare needs. So every every situation's been different when I go out and have an appointment with somebody or talk to 'em over the phone.
Speaker 1:Great. We're gonna take a break and I've got a lot of , of questions for Hunter about the whole process and tips and, and questions that people should be asking. So let's take a quick break. Welcome back to Winning Isn't Easy, hunter. I've learned a lot during the first part of our uh, podcast, but I've got lots of other questions that I wanna ask and I know that my clients would be , uh, wanting to get answers from. So tell us what are the three common questions that you get? Uh, and then I'm gonna ask you, what are the three common questions that people don't ask you that they should be asking you? So let's start out with what are the common questions you get?
Speaker 2:I think the most common question I get is, do I have to wait for annual enrollment to change my plan ? And there's a , there's a lot of different election periods out there that people are unaware of. Um, there's election periods for if you've moved, and one of the biggest ones is a chronic condition. If you've just , uh, so take for example, maybe whenever you signed up for a plan back a year or two ago, all of a sudden you found out that you have high blood, blood sugar, or high blood pressure, and it's kind of an , a new thing for you. A new onset disease or condition that you have that opens up a election period for you. Also, there's certain plans, they're called chronic special needs plans, and that opens up an election period throughout the year, and you don't have to wait for that annual enrollment period.
Speaker 1:I have a question. So when you say there's an election period , uh, do, let's say I was just diagnosed with high blood pressure. Do I have to , uh, enroll in , um, this , uh, can , can I enroll in a a , a change program immediately or is there a time limit that I have to do it in like 90 days or I lose my opportunity?
Speaker 2:So that's if, lemme see. So with the chronic conditions, no, you don't have to change right away. A lot of the times you may wanna at least look into it because there's times where the prescriptions, I know some of the, some of the medications that they have for these chronic conditions, they could get expensive. Mm-hmm . <affirmative> . So those plans get more funding so they're able to help save some money on your prescription costs , and a lot of times they'll, they'll bring in lower copays, things like that. So you don't have to change and there's no timeline for it. It's just if you're, if you have a new chronic condition, it's definitely something to consider. And that election period allows you to change if you do determine that that's something that you wanna do.
Speaker 1:Great. So you gave me one common question. What are the other two that you get?
Speaker 2:Other two. I think one of my favorite ones I always hear is why do I get so many phone calls <laugh> from insurance agents , <laugh> ? And uh, I know for me, I, you won't get a phone call from me if we haven't met face to face or you haven't reached out to me, maybe you got my business card or a flyer or something. We have limitations that where we have to have scope of appointments. We're not allowed to reach out to you without permission from you. Um, another thing is with people call into these commercials, then a lot of the times they put you down on a call list and you start getting phone calls from, from marketing people trying to get you to look into, oh look, look at this benefit. They , uh, they'll continually call you. I've, I've been in appointments before where I've had the lady sitting in front of me get 10 phone calls.
Speaker 1:Oh my goodness.
Speaker 2:I'm sitting there and she's like, I, I just don't answer 'em anymore. Her phone just constantly going off. I, I felt pretty bad. 'cause that is just a , it's very frustrating and annoying when your phone's going off like that.
Speaker 1:It is . So are there any other common questions that , uh, we wanna cover that you get before I ask you the questions that they should be asking you? But they aren't
Speaker 2:The , I guess the other one is just they see the commercials and they ask if they're, they qualify for the food cards or the, the extra benefits on top of it, utility help, things like that. A lot of those have to deal with your dual plans. So that's having Medicare and Medicaid and then some of the chronic special needs plans. Some of those give you a small allowance. Um, that would be the, the third, third most common question that I hear.
Speaker 1:So as I have teased what I wanna know is what are the questions that you w wish people would ask but they don't?
Speaker 2:I think my big thing is just ask the questions. Ask the questions that you, you're not sure about. Um, any questions? A good question to me. 'cause that makes me know that you're, you're willing to look at the different options to see if there's places that you can save money. Um, the one I would say that people need to ask more, more often is, are my doctors in network? Are my prescriptions covered? I think a lot of people out there, they'll just overlook the prescriptions, but you don't realize how big of a difference going company to company that the prescription costs can, can change up and down those tier levels.
Speaker 1:Okay. So should individuals reconsider their coverage every year or, you know, I bought a policy a year ago, two years ago, you know, it's fine and I, I don't have time to pay attention to it. If, if something's wrong, somebody will let me know. What's the answer to that?
Speaker 2:Definitely look into your, your coverage annually. A lot of the times, even if it's within the same company, these companies roll out new HMOs. They roll out new PPOs to where the older plans, they may not cut them off to where you still have your old plan, you still have coverage. But that may be a outdated plan where there's another plan out there that is going to save you in your max out of pocket , save you and your copays and just add more benefits on, on top of what you've already had.
Speaker 1:So it is nice to get a tune up or a checkup, but you don't necessarily have to change. But, you know, it is sort of like getting your annual physical right?
Speaker 2:It's, you wanna make sure that there's not an upgrade out there. You're missing out on it ,
Speaker 1:<laugh> great. Great. And when a person , uh, approaches you and says, I , you know, I, I want you to, to look at what I've gotten and , uh, tell me if there's anything , uh, new or better. Is that any different than the original process that they've gone through to say, Hey, I wanna enroll in something? Or is there, is , is it the same process?
Speaker 2:A lot of it's the same, but at the same time there , I always ask those questions about the network. 'cause if you're staying local and you're not traveling a whole bunch, and there may be a local plan that's gonna lower your costs tremendously.
Speaker 1:Well certainly o o one incentive to, to do this annually as you've said, is if there've been a person has been diagnosed with a new chronic condition, or maybe perhaps the prescription that they're taking is increased in price, would that be right?
Speaker 2:Yes, ma'am. Yeah . You never, as, as you age, get older, there's always new conditions. I mean, whenever you go to the doctor, you wanna have a good doctor that checks in on you. Mm-hmm . <affirmative> kicks the tires a little bit. Make sure that they're, they're keeping you healthy. 'cause that that's gonna make you happier. It's gonna gonna keep you active. So it's, it's good to always check in with your doctor, make sure that they're, they're checking you out, making sure you're staying healthy. And the health insurance plan can help you save money as you're getting all that done.
Speaker 1:Great. So what are the three tips that you would have for our audience about how to choose a plan that's right for them that meets their needs?
Speaker 2:Question ? Uh , the , the first one I would say is if you're new to Medicare and you're during your, they call the I C E P , it's your initial coverage enrollment period, that is a chance where you can look at supplements and you don't have to go through the, the underwriting. There's a guaranteed issue at that point to where you can buy into it. And it's only during that seven month period that you're able to look at those and rule out, no matter if you've got a, a chronic condition or , or a health problem, they are not allowed to turn you away at that point. So that's, that is one of the biggest things. If you're new to Medicare, make sure you at least know about those. Ask the questions about it because it's a good opportunity for you to at least consider it.
Speaker 1:So before we move on to the other two tips, can you explain what a supplemental policy is?
Speaker 2:So supplemental policies, those are, those are plans where you don't have a network of doctors like the Advantage plans, these are typically plans that you can see any doctor that accepts Medicare and that's throughout the country. And it's typically a higher premium that you're paying upfront and de depending on which, which plan you go with, there's set limits on how much you're gonna spend.
Speaker 1:Okay. And so what are the other two tips , uh, for choosing a plan that you would share with our , uh, audience?
Speaker 2:The other tip is, I think I've gone over it a couple times, where do you seek your routine care at? If it's local, definitely take a look at your local plans, see if there's one that has your doctors and that way, or doctors and prescriptions. And that way you can see if there's a plan that's gonna help you save some money. And if it's a, if you're a traveler, you like to go all , all throughout the country, then look into those other plans, make sure you have that coverage wherever you go. And even with the local plans, if you travel, you're still gonna have emergency room care and you have urgent care throughout the country and worldwide.
Speaker 1:So give us a couple tips in , in closing as to how to find an agent like you who is really interested in helping me meet my personal needs and just isn't interested in the commission that you might earn.
Speaker 2:Well, I'm, I'm always here if, if y'all need to reach out to me , um, make sure that y'all, y'all see which companies they represent. Um, captive agents, they are there, which not saying there's anything wrong with it, but they have a set amount of plans. And not every, not every plan is suit suited for everybody doesn't fit everybody. So finding a, a broker that's contracted with several companies, that really helps you expand your options and make sure that you're not missing out on something. So that way whenever you have the TV turned on and you do see the commercials, you're like, I, I know I'm good. And it doesn't raise those questions and have somebody that you can reach out to that you can get ahold of. Mm-hmm. <affirmative> .
Speaker 1:Well, I think you made a good point. Uh , my dad, my dad's family had an independent insurance brokerage firm in Baltimore when I was growing up. Uh, and he wasn't a captive, in other words, he didn't, he was , wasn't just an agent for nationwide, he wasn't just an agent for , uh, Allstate. And the same holds true , uh, here in the healthcare world. Correct. You as an independent agent are gonna represent a number of carriers or plans and be able to offer that smorgasborg to your clients. Is that correct?
Speaker 2:Correct. Yes, ma'am.
Speaker 1:Uh, and is there a typical for an independent agent , uh, and the number of carriers that they might deal with , uh, as opposed to, you know, you know, I'm a captive agent for, you know, United, for example , uh, but as an independent I might represent 3, 4, 5. I mean, how , how many is it common for an independent agent to, to , uh, to represent?
Speaker 2:So it really can just range. Every state has different companies in them. You have a few carriers, so I, I'd probably say four, four or five six carriers that are probably throughout the United States. And you'd probably do good , uh, to have those, just those. But depending on which state you're in down here, there's a little over a, maybe even a little bit more, over a dozen different companies that you can pick and choose from.
Speaker 1:Um, is there any kind of rating agency that somebody needs to be aware of that rates these particular carriers so that, you know, when I would be talking to you, I would know that this particular carrier's got a C rating, but I, and by the price might be good. It's a C company and I really want an A company.
Speaker 2:So I know medicare.gov, they have a lot of information on their website, healthcare.gov. Uh , I believe it was medicare.gov that you can go through and see star ratings and all the different ratings. And actually you can see all the different plans on there too. That's a great resource to look into. And that, that's where I would start if I was looking to see the full range of it per state.
Speaker 1:Well, I know the whole process is confusing, which is why , um, we refer our clients to you and of course we don't get a commission for that. We don't get any kind of kickback or commission or any kind of payment. We recommend , uh, hunter because of the , the skill that he has and the great working relationship he has with our clients. If, if anybody wanted to contact you to learn more about the , uh, the Medicare policies or to even talk with you , uh, about their particular situation, how would they get ahold of you?
Speaker 2:So I've got my, my phone number. I have a one 800 number. It's 1-833-VOL-PLAN , v o l , and then my email's hunter@vohealth.com.
Speaker 1:All right . And could you spell that out for us please?
Speaker 2:Let's , yeah . So Hunter, h u n t e r dot v o l , like the volunteer state.
Speaker 1:Ah ,
Speaker 2:H e a l t h health.com
Speaker 1:That we, we know where Hunter is from <laugh>.
Speaker 2:Yes, ma'am.
Speaker 1:All right . Well, I thank you for your time today, and again, I I thank you for the great work that you do for our clients , uh, and, and the great work that you do in the community particular here in , uh, in Pasco County in Florida. Thanks.
Speaker 2:Yes, ma'am. Thank you so much for having me today.
Speaker 1:Our pleasure.