Medicare Masterclass: Essentials for All Ages

Arnold Stricker
00:00:00

If you are approaching Medicare age, or maybe you have a parent who's approaching Medicare age, or maybe you're even on Medicare, you may want to pay attention to this particular show because there's misinformation going on about Medicare. We're going to answer some of the top things that you need to know about Medicare, some basic understanding of Medicare and what about dates?

All this on St. Louis and Tune. Welcome to St. Louis in Tune.

And thank you for joining us for fresh perspectives on issues and events with experts, community leaders and everyday people who make a difference in shaping our society and world. I'm Arnold Stricker along with co host Mark Langston. Mark, it's been a while, sir.

Mark Langston
00:00:52

Yes, it has been. I've been just kind of traveling around.

Arnold Stricker
00:00:57

The holidays do that?

Mark Langston
00:00:58

Yeah, yeah. The end of the year, we made it. We actually, we went to Orlando for about a week, 10 days.

Arnold Stricker
00:01:05

Right.

Mark Langston
00:01:05

When that big. I'm not sure when this is playing back in the. In the future, but there was a big ice storm in St. Louis.

Arnold Stricker
00:01:12

Yes.

Mark Langston
00:01:12

We were in 72 degree weather, so it was kind of nice.

Arnold Stricker
00:01:15

And they're getting snow right now.

Mark Langston
00:01:17

Yeah, I know. What. Yeah, yeah. No, there's no global warming though. Okay. Just to make sure you.

Arnold Stricker
00:01:22

Global snow.

Mark Langston
00:01:22

Yeah, global snow. It's that too.

Arnold Stricker
00:01:24

Well, we're glad that you have joined us today.

You can listen to previous shows at stlintune.com; please help us continue to grow by leaving a review on our website, stlintune.com, apple podcast or your preferred podcast platform. Our return to civility today is show appreciation and empathy for a mother or father struggling to control a screaming child.

Let them know you appreciate their effort or that you've been in their shoes before. See if they need help carrying things or opening a door or offer to get something for them.

You know, especially like in an airport on the plane in the grocery store.

I was at the grocery store the other day and I heard this screaming child on the other side of the store and it gradually got louder and louder and they turned down the aisle that I was in and it was like, okay, okay.

Mark Langston
00:02:11

I know, I know.

I have a niece who just got on a plane to go back to Colorado, Denver, and she has like 8 month old and she told us that she had to change diapers twice. Where do you do that on an airplane? That's what I wanted and I don't want to be sitting next to those two.

And I love her, but I understand, I get the whole thing.

Arnold Stricker
00:02:35

And it's tough traveling with youngsters like that.

Mark Langston
00:02:37

Oh my, yes.

Arnold Stricker
00:02:38

You know, the air pressure change.

Mark Langston
00:02:40

Empathy is a good way. Yeah. Be nice to people, will you?

Arnold Stricker
00:02:42

Show appreciation and empathy for a mother or father struggling to control the screaming child. Well, we don't have any screaming children in studio today, but we have some great information that's going to be given to listeners about Medicare.

Dan Mangus is vice president of growth and Development for the Senior Benefit Services. He is a longtime insurance agent, insurance kind of guy back from when he was 18 years old.

He started his first agency at 18 and he's been passionate about educating others about their insurance choices ever since. And I could go on with his resume because this is his second time on the show.

And you all need to go back to the Medicare, the ABCs of Medicare that we have and we did about five years ago and I'll put that on the podcast page. But Dan is here also with Luke Acheson and they're going to talk to us about some changes that have occurred in Medicare. Dan and Luke, welcome to St.

Louis in Tune. Dan, welcome back.

Dan Mangus
00:03:38

Thank you so much. I love being here.

Arnold Stricker
00:03:40

We've got a lot of questions today. I guess first thing are what's a, like a quick overview of Medicare? What's a basic understanding of Medicare that people need to have?

Dan Mangus
00:03:53

Yeah, I think it's important to understand the objective that they're trying to accomplish with Medicare, providing insurance for individuals who are either managing into Medicare or on Medicare because of disability, because the needs are all specific to that. So some of the basics and I'll cover a couple. And Luke, if you want to cover a couple, there's four primary parts of Medicare.

The first two parts I'll cover. That's Part A of Medicare.

Medicare Part A has a benefit period that starts that kind of triggers Medicare Part A, which is triggered by going into a facility. If that happens, then there is a deductible that an individual has for going into that benefit period.

And Medicare Part A covers the hospitalizations or a facility that a person may be being carried in and those types of things. So it's very often referred to the hospital portion of Medicare. Medicare Part A.

Medicare Part B is physicians and outpatient treatment and durable medical equipment, things that an individual is going to receive in that type of a sitting. So providers are usually covered by Medicare Part B.

Medicare Part B does also have an annual deductible and then it has a CO insurance amount that a person is responsible for. Depending on the type of program that they have, they may have CO pays In that sitting, they may have coinsurance in those settings.

But Medicare Part B is really the physician and provider side of Medicare.

Arnold Stricker
00:05:23

Okay.

Luke Atchison
00:05:24

Yeah, certainly. And I think kind of following that, you know, there's Medicare Part C that comes after.

And Medicare Part C is a little different than the first two components where it's segmented into inpatient and outpatient. Medicare Part C is kind of a catch all insurance. It has inpatient, outpatient, and also drug coverage included into it.

And it's facilitated by private insurance carriers.

Now, it requires you to have Medicare parts A and B to enroll in Medicare Advantage, but it is certainly, you know, a little different than original Medicare in regards to coverage and costs associated with it. And then finally, the last part of Medicare is Medicare Part D, which is your prescription drug coverage.

And that, again, is also facilitated by private insurance carriers. They have certain regulations, you know, set in forth by the government.

They have to meet with their coverage in regards to cost, prescription coverage, deductibles, things like that. But all those elements come into play when we speak about Medicare prescription coverage.

And really identifying, you know, from the plan as well as the company that you're being insured with is an important part based on medications you take and things like that.

Arnold Stricker
00:06:29

And there's Medigap, too. Medigap coverage, which are a couple other letters.

Dan Mangus
00:06:35

Yeah, you know, because that is interesting. You know, like Luke was just saying that Medicare Part C is handled by private insurance companies. So it's really.

When Medicare is handled by a private insurance company, Medigap plans help to cover whenever you're using what they call original Medicare. Is Medicare the parts A and B. And you don't have the private insurance company providing those. You have the federal government providing those.

However, it does not cover 100% of a person's treatments or items that they're getting cared for. And so it leaves the copay and coinsurance amounts.

And that is where a Medicare supplement or Medigap plan steps in and helps to carry, you know, to cover that.

Arnold Stricker
00:07:17

Now, there have been some changes with Medicare Part D just recently, within the last several months. What are those changes and what can people expect because of those changes?

Dan Mangus
00:07:28

Okay, I'll be happy to address that. Or if you want to, Lou.

Luke Atchison
00:07:31

Yeah, I can jump in on it.

You know, essentially the big kind of change that has really affected prescription drug coverage and Medicare Part D as a whole recently is the Inflation Reduction act. That was approved back in 2023, but it just kicked off with Medicare January 1st of 2025.

And essentially what that's doing is it's changing drug coverage in several ways. It is eliminating what many people have probably heard of, which is called the donut hole or the coverage gap of Medicare prescription drug coverage.

And it is also lowering the maximum out of pocket or the true maximum out of pocket for part D all the way down to $2,000. So it's a massive shift in regards to how prescription drugs are filled, what the costs are for them.

In some ways there are improvements to that, but we've also seen some kind of shifting backwards in regards to some of the cost.

And so, you know, it's really kind of change the landscape in regards to what drug plans are most appropriate for individuals and, and how prescriptions are covered as a whole, you know, all the way from the simple generic medications to the very specific brand name medications.

Arnold Stricker
00:08:32

So let's go through a little example of that, Luke, just to make sure people understand what are the positives, the, the upside and the downsides of this change is that you mentioned that the annual, I guess I'm going to call is it out of pocket, just $2,000. So if I'm getting prescription drugs and I pay $2,000 out of pocket, this is my annual cost. What happens after that?

Luke Atchison
00:08:57

Yeah.

So essentially once you've kind of hit your maximum out of pocket with medications covered by your insurance, then you're done paying for the remainder of the year for co pays or coinsurance for those medications. You're still responsible for your premium if you have one on your insurance plan.

But at the pharmacy you should have no, you know, billing amount due after you've established or after you've hit your maximum out of pocket.

You know, the kind of interesting thing about the $2,000 maximum this year is it's not in some cases really requiring people to actually pay $2,000 out of their pocket.

There are circumstances where, because the way that that maximum is calculated, people are hitting that when they've only spent maybe fifteen hundred dollars out of their pocket and then those costs go to zero or even less than that in some cases.

Arnold Stricker
00:09:40

Because are these are out of pocket or is this the insurance cost plus my out of pocket combined together?

Luke Atchison
00:09:45

It's a mix. It's not necessarily insurance pays and you pay going together.

What they're doing is they're calculating that $2,000 cost based on what you pay out of your pocket or 25% of the retail cost of a medication.

Arnold Stricker
00:09:58

Okay.

Luke Atchison
00:09:59

Whichever one of those numbers is higher is what they count towards it. So for example, if I'm on a Medication that has a $500 retail cost, you know, 25% of that's $100. Maybe my co pay on my insurance is only 50 for that.

But so every month when I pay 50, 100 is going towards that maximum. So I could hit that faster than I really am actually spending the 2,000.

Arnold Stricker
00:10:20

That makes a lot of sense. That makes a lot of sense. Dates are very important in Medicare coverage, open enrollment, especially if you're wanting to change plans etc like that.

Dan, talk about that. What are the key dates? What are some things that people need to remember?

Dan Mangus
00:10:35

Yeah, I appreciate you bringing that up because a lot of people don't realize how things are necessarily regulated. Medicare Part C or Medicare Advantage programs, prescription drug programs, are federally regulated.

And the federal government then dictates when a person can enroll in one of those or not enroll in those. So there are specific dates around when a person becomes initially eligible for programs, and those vary kind of depending on a person's situation.

But annually there's an annual enrollment period that runs from October 15th to December 7th, and that allows individuals to change the plans for the coming year. So our 2025, if you will, everything that was effective January 1, the enrollment for that started October 15 and ran to December 7.

So if somebody has a Medicare Advantage plan or a drug plan and they need to make changes, that's when they can make it. Then there is some other dates that are relevant.

If a person was notified by their Medicare Advantage plan that their plan went away, and that happened, by the way, with about a million and a half people this year, a very, very disruptive year as far as that goes. That's called a service area reduction. And that allows for a person to enroll into a different plan using what's called a special enrollment period.

And then special enrollment period for that ran from December 8th to the end of February. So we're still in the middle of that.

So if you lost your plan, if you were notified you lost your plan, you are still in a situation now as we speak here in January, to be able to change that until the end of February. Then there is what is also a little confusing for people, another what they call open enrollment period.

But it's the Medicare Advantage open enrollment period.

And it's similar to a 90 day free look, basically for individuals that have Medicare Advantage plans, that does not apply to people that have just individual prescription drug plans.

So like you were talking a minute ago about Medigap, if you have Medigap and a prescription drug plan, there's not another open Enrollment outside of the annual enrollment period that allows an individual to change every year. There are obviously special situations around everything, but this open enrollment period runs from January 1st to March 31st.

And so it allows individuals who are in a plan, let's just say that you've had a health condition change first of the year and you need to make a change in your program. You can make that during that period of time.

But if you have just a Medicare supplement prescription drug, you can't make a change during that period of time because of the open enrollment period.

So you can go from a Medicare Advantage plan, however, back to original Medicare, but that does not create a guaranteed issue period for Medicare supplements. So you have to be very, very careful.

So if you go from a Medicare Advantage plan that includes your drugs to just a standalone drug plan, you can do that, but that does not guarantee that you can get the health insurance side of it, the Medicare insurance Medicare supplement. So you need to make sure of.

Arnold Stricker
00:13:40

That because there may be underwriting involved with that.

Dan Mangus
00:13:42

Exactly, exactly.

But if you want to go from one Medicare Advantage plan to another Medicare Advantage plan, you can do that during the Medicare Advantage open enrollment period. So those are some key dates there that are in relation to that. And then there are, like I mentioned, some special enrollment periods.

We were talking about the weather right before we went on air. FEMA has special enrollment periods around disasters that allow individuals to make some changes based on that.

There's other situations that create special enrollment periods. So you need to make sure that if you have a situation happening that you check out and see if there are some allowances for that inside Medicare.

Arnold Stricker
00:14:20

Okay? So I can see people listening that are just like their head spinning right now, kind of like Linda Blair in the, in the Exorcist.

And they're, and they're like, oh, my gosh, these dates. Oh, Medicare supplement. Oh, Medicare Advantage plan. And exactly. It is, I know, Consider Medicare.

Dan Mangus
00:14:38

What.

Arnold Stricker
00:14:40

Where can people go to get some confident advice? Because obviously there are insurance companies. They're going to spin, my words.

They're going to spin things to grab you in because they want you as a client. Okay? That's why Joe Namath gets on there and all these other retired people like Henry Winkler around anywhere between October and December.

And they're, they're saying, you're standing by the fire and saying, yeah, you can get free dental and free vision. And we'll, we'll even throw this in. We'll, we'll throw in a free car. No, that's not true, folks. So where can people go who need to.

I just want some straight scoop. I don't want misinformation. And we're going to talk about misinformation. Where can people go, guys?

Luke Atchison
00:15:20

Yeah, I mean, there's certainly a couple options. You know, I want to lead first and foremost with going directly to the source that provides Medicare.

You know, Anyone can call 1-800-Medicare and get some kind of really basic general information provided from them in regards to eligibility of changes, explanation of, you know, basic Medicare principles, rules that the insurance companies have to follow. You can call and get a lot of that, you know, really unbiased breakdown straight from the source.

It's a great tool that I think is probably underutilized by a lot of people.

But, you know, further than calling 1-800-Medicare or getting on medicare.gov which is the government sponsored website, you can call, you know, local agencies, local resources in your area. There are obviously national 1-800-Numbers that you can call and get in touch with licensed agents who, you know, know a lot about this stuff.

But if you want someone who, you know, can come and explain it to you in person and kind of be a continued resource, that's where there's really an opportunity everywhere in the country to find local health insurance agencies that specialize in Medicare and reach out to them to get those questions answered.

Arnold Stricker
00:16:22

Is it best to do that or best to find a broker who covers a variety of things, who really doesn't care that hey, I'm getting commission off of this particular plan or something? Are there ups and downs or positives or negatives about going to a broker versus going to just some basic Medicare insurance provider?

Dan Mangus
00:16:40

I love that question because there used to be a lot of individual agents that were affiliated with just a specific carrier. You don't see that as much anymore. It was kind of the norm for many, many years.

But most, almost every agent that works in the Medicare space is going to offer a large variety of carriers.

One of the things to keep in mind too is that if they're in the Medicare space, they have had to complete certifications every year and be trained specifically on one of the courses is fraud, waste and abuse. Then they have to have a course of certification for each carrier that they're dealing with.

So they have to understand that carrier's way of doing business and their expectations. And it also includes all of the federal required training.

So anybody that is actually able to help and facilitate enrollments has gone through all of that certification and training every year. In addition to each state has their own continuing Education for that agent and their own licensing age.

So there's a lot of different hoops that those individuals have jumped through ahead of time. That does not make all advisors equal by any means.

One of the things I always recommend is to talk to some of the people that they've worked with in the past.

If they don't have a friend of yours or something that they've worked with and they really know that this person is really on top of their game, then when you meet with an agent, ask them, say, hey, I want to see some testimonials. I want to see some.

Some individuals that you've worked with before, and I want to have the ability to be able to reach out to one of them if I can, and ask them how it went.

Because one of the things that is true, and I know Luke would agree with this, is that there are no two individuals that are exactly the same that have exactly the same needs. In fact, very often a couple will need one type of program for one person and one for another.

But our industry itself has moved into some very, very small, specialized products, much more than it was even two or three years ago.

And it's continuing to move more and more in that direction with chronic special needs plans and different things that are just really designed for that individual. And so the medicines a person takes, their health conditions and all this dictates that.

And a good advisor, just like a good physician, will know how to diagnose the right kind of plan for the right person.

Arnold Stricker
00:18:59

Excellent point. So we're talking to Dan Mangus and Luke Atchison.

They both work for Senior Benefit Services and out of Columbia, Missouri, matter of fact, but they work with a nationwide group. And matter of fact, Dan does training for what I would call insurance agents all over the country as it relates to their training services.

This is Arnold Stricker with Mark Langston of St. Louis in Tune. And this is a real important topic, and that can confuse a lot of people. A lot of misinformation out there.

What would be some warning signs or some misinformation that you would let people know, hey, just be careful about that.

Luke Atchison
00:19:37

Yeah, I mean, I think that generally speaking, unfortunately, a lot of marketing around the Medicare space is really trying to cast a wide net and kind of playing off what Dan just said. Really, it's. It's so individualized and specific.

If your neighbor says, oh, I'm on this insurance and it's great, that does not mean that, you know, that.

That their neighbor should say, okay, I'm going to sign up for that same one because it's so, you know, there's so much minutiae to what makes an insurance product appropriate for someone. And so I would say being cautious of marketing that acts as though, oh, we've got the plan for you before they know you.

That's a, that's a difficult statement to make.

Arnold Stricker
00:20:11

Did you hear that Joe Namath and Henry Winkler?

Luke Atchison
00:20:16

Yeah. So it's, you know, you're, you're absolutely right.

There's misinformation and, and a lot of that comes not from a nefarious standpoint, but really a, just a confused standpoint. There's a lot of intricate moving parts to Medicare.

And you know, what you hear from your neighbor versus what you hear from TV versus what you get in the mail versus what you get on the phone call, it's all going to be different and conflicting.

And so that's where trying to, you know, listen to the individuals or the resources that are, you know, backing their claims up of, you know, not, oh, you can get this. But hey, here's why.

This is something that's available to you and, and going down to the, the root of, of issues or benefits or what have you is in my opinion probably the best way to suss out what's accurate and what isn't.

And then again, falling back on kind of third party, everyone gets a Medicare and you handbook every year that, you know, has a lot of this detail included.

If someone's makes up, makes a claim to you and it sounds like it, you know, either is possibly too good to be true or maybe something you're really interested in, but you want to verify the authenticity of it, grab that book that you receive, flip through it and try to identify that information for yourself. And if it comes back looking pretty accurate, then hopefully you found something that's.

Arnold Stricker
00:21:22

A good fit for you, that's good information.

Dan Mangus
00:21:24

What are some, you know, I might, I might add to that too real quickly is that you got to be very careful making assumptions when you're.

Whenever I see things that throw up red flags for me is whenever I see people focusing on things that are very irrelevant as far as the huge cost of healthcare.

You know, the primary things that are going to cost somebody a lot of money are serious health conditions and hospitalizations and expensive medications, expensive ongoing health care. It's generally not a gym membership that's going to make or break somebody's finances.

And so making sure that the advisor is really focusing on things that are truly relevant to you and not trying to flash little bells and whistles at you that, that might be nice, but they're not really at the core of why you're really purchasing the insurance program in the first place.

Arnold Stricker
00:22:15

So sifting through a lot of that, you know, I kind of consider this, like if you're sifting looking for gold or, you know, screens that are for gravel, what are some mistakes that people make along this hoist Medicare path? And I see that we're gonna, we're gonna come up on a break, so I want you guys to kind of think about that.

Is it, you know, missing the enrollment dates? Is it not opening up those, those letters that Medicare sends out?

Is it not going to the website that says, when you get an email that says, hey, you've got a new message from Medicare or, you know, your agent or broker doesn't contact you or say, yeah, you've, you know, part D is changing or gee, you know, I didn't know my, my, my Medicare Advantage plan was going to go defunct here recently. Now what do I do? You know, what are some mistakes that people make in going into Medicare, during Medicare and those kinds of things?

So we'll come back to that and also want to ask what are the key questions people should be asking specifically and who should be asking those questions? You know, is it like a family member? Is it, you know, a husband for a wife, a wife for a husband? What if somebody's incapacitated?

Who should be doing all those kinds of things like that? So we're going to come back, take a little brief break. This is Arnold Stricker with Mark Langston of St. Louis in Tune. Don't go away.

This is Arnold Stricker of St. Louis in tune on behalf of the Dred Scott Heritage Foundation.

In 1857, the Dred Scott decision was a major legal event and catalyst that contributed to the Civil War. The decision declared that Dred Scott could not be free because he was not a citizen.

The 14th Amendment, also called the Dred Scott Amendment, granted citizenship to all born or naturalized here in our country and was intended to overturn the US Supreme Court decision on July 9, 1868.

The Dred Scott Heritage foundation is requesting a commemorative stamp during be issued from the US Postal Service to recognize and remember the heritage of this amendment by issuing a stamp with the likeness of the man Dred Scott. But we need your support and the support of thousands of people who would like to see this happen.

To achieve this goal, we ask you to download, sign and share the one page petition with others. To find the petition, please go to dredscottlives.org and click on the Dred Scott petition drive on the right side of the page.

On behalf of the Dred Scott Heritage foundation, this has been Arnold Stricker of St. Louis Intune. The United States has a strong tradition of welcoming newcomers and refugees.

The welcome Corps is a new service opportunity for Americans inspired to welcome those seeking freedom and safety and in turn help strengthen their own communities. Welcome Corps is a public private partnership that is inspired by what Americans represent to so many around the world. A beacon of hope and refuge.

All it takes is a helping hand. Are you ready? To learn more, contact the International Institute of St. Louis at infoistl.org or call 314-773-9090.

That's infoiistl.org or call 314 203-9090.

Mark Langston
00:25:33

Tickle those ivies.

Arnold Stricker
00:25:38

Welcome back to welcome Back to St. Louis in Tune. This is Arnold Stricker with Mark Langston. We are talking all things Medicare and.

Mark Langston
00:25:47

We have Dan, My head is spinning like Linda Blair. It is. My head is spinning. So there's so much and it's only A, B, C and D. Yeah.

Arnold Stricker
00:25:55

And that's why I really encourage people to go back and listen to the episode we did the podcast. It's on the podcast page, STL and tuned, and it's entitled the ABCs of.

Mark Langston
00:26:06

Medicare and should be the ABCDs of Medicare.

Arnold Stricker
00:26:11

Yeah. Yeah. Well, you know. Yeah, well, there's a whole lot of alpha. I think I may have called it the Alphabet Soup.

It is of, of Medicare because there's, there are a lot of letters involved and some of the letters have gone away. Matter of fact, it is called the Alphabet Soup of Medicare. Abcd, F, G, K, L, M and.

Mark Langston
00:26:28

N. What, what show is it? Do you have the show number there by chance?

Arnold Stricker
00:26:31

See, I don't. It's December 1st of 2020.

Mark Langston
00:26:36

All right. And I know Dan is going to have a lot of. Get a pen ready because he's got a lot of website addresses.

Arnold Stricker
00:26:41

Yes.

Mark Langston
00:26:41

He's going to give us here in a little bit. Is there, is there one Medicare card that someone that has no money that's, you know, can get without a premium to pay?

Luke Atchison
00:26:55

Yeah.

I mean, not necessarily a catch all card that you have where, you know, all of a sudden you have, you know, full coverage and no premiums and all this stuff. But that's where there's a lot of layers to, you know, options that, that people can pursue.

For example, when you have Medicare and you kind of are, you know, really in a low income category and you need support from, you know, different areas to save on costs at the state level and I believe are all, but if not all, most states offers a program called a Medicare savings program where they can basically pay your Medicare premiums for you.

And some cases you can have that in conjunction with medical coverage through Medicaid that can then pick up coinsurance and co pays things like that. All right, so it's, you know, it's hard to say, oh I'm going to flip this switch and get the, the full, you know, gamut of it for no cost.

But there's definitely levels to that, especially for people who are really in need of, you know, cost saving and still having good health care.

Mark Langston
00:27:47

Right. I think that's so important, you know, that there are people out there that just can't afford it, any one of the add ons to it.

So to help them out, I think that's great. And it still annoys me that insurance is different by state. So I can't go across state lines to pick up a better plan or with it. I don't.

I mean that's. Isn't most of our stuff restricted to Missouri that we can buy?

Luke Atchison
00:28:10

Yeah, that's correct.

In regards to state by state, there are some differences and variations and the insurance options available to you are based on state that you're a resident of. However, there are some similarities state to state and there's certainly access to care crossing state lines.

So even if you were to travel, you know, let's say from Missouri and you were staying in California, if an emergency were to arise or things like that, you know, you're absolutely going to have care in that circumstance. Medigap policies that we discussed earlier, those are national, they work, you know, functionally the same in almost every state across the country.

So that's where certain things there are a geographic component, certain things not so much. And again, that's all about kind of identifying the specificity of what insurance is best for you.

Mark Langston
00:28:53

And that's why my head is spinning.

Arnold Stricker
00:28:56

And that's why we're doing this. And it's important to kind of from, from my vantage point that before you reach 65 to kind of start investigating, start checking this out.

If you've got a parent who's approaching that age, encourage them to start checking that out and you check that out.

If you're a child of somebody who's approaching the age of Medicare and even if they're in Medicare keeping up with some of those things for them because you know, they may be watching Broadway Joe Namath, you know, in his, in his mink coat, you know, you know, given trying to do the sell on the plan. But you may be like no, that's not what's best for my parent.

So mistakes, what have you guys found that are some of the biggest mistakes people make make with, with Medicare?

Dan Mangus
00:29:40

Well, one of them. I'll start right off with what you were talking about with, with what can you find that is not any premium.

There's a lot of individuals who cannot afford to have some of the zero premium programs that are out there because anytime that there is something that sounds too good to be true then it is too good to be true. That is a, that is a fact.

And so when you have programs that are zero premium there is going to be coinsurance and copay amounts and it's going to be more of a pay as you go. And for some individuals that can be extremely cost inhibitive. So they may go into a program because they can't afford the premium.

They want to have something at zero premium. They feel good because they have insurance.

And it is true they do have some insurance, but it could leave them with very large bills to pay if they have care that is ongoing or even something minor can turn into some pretty good sized expenses. And so you have to really watch that.

So watch not just what your premium costs but what your health care will cost over that year period of time and plan for the unexpected.

I mean that is truly something that a lot of individuals try to make decisions based on what their health was like on January 1st when they started out. But that's not the reality. The reality is all of us have things happen as the course of the time goes on.

And if it does, you may have been a healthy person going into the first of the year and made a decision based on being a healthy person and then have some serious health condition that happens two months later.

So what I always recommend is there are other insurance programs that can help to assist with those gaps that, that are created even by Medicare Advantage.

So a lot of times people think, well I have a Medicare original Medicare, so I'm going to carry a Medicare supplement to help cover the caps and coinsurance.

But then they purchase a Medicare Advantage and they don't think about purchasing what would supplement that and pay the caps and the coinsurance and the co pay amount. And so there are programs out there that you definitely need to have.

So very often an individual needs to be very careful if their finances are limited.

Like Luke said, there's definitely programs out there on a state by state basis because states manage Medicaid, which will help to cover, you know, financial assistance that way. But there are also health insurance programs out there that individuals can have.

So I think one of the mistakes that people make that I think is one of the biggest mistakes is they don't use their health when they have it. You know, if you have the health ability to purchase something to insure against some of those kind of things, use your health.

It's not just money you buy insurance with, it's also your health.

Arnold Stricker
00:32:23

Give an example of that.

Dan Mangus
00:32:25

Okay, so let's just say an individual goes into the beginning of the year and they have no health conditions at all. They take out a Medicare Advantage plan and that plan has a $4,000 maximum out of pocket on it.

Come October they develop cancer and that treatment starts and they maximum that out with the chemotherapy and treatments and things like that. So they spent 4,000, but then the new year starts and they spend another 4,000 or whatever.

The maximum out of pocket is for their Medicare Advantage for the next year. So they have two years there of spending.

They could have purchased a cancer insurance program or a indemnity type program that would have helped to cover those expenses if that had happened at a very low cost. But now that they have cancer, they can't get it right.

So they should have been able to been advised by a good advisor to say, hey, listen, it's very, very hard. And I'm not encouraging buying insurance when you don't need it. I never would do that. That would be a silly thing to suggest.

But it is very hard to be on overinsured in a world that health care costs what it does right now. So just plan for not what your current situation is. And a lot of people do that with drug plans. They do that sometimes.

They don't even carry a drug plan because they don't take any medicines. You don't know what you're going to be taking two months from now, you know, so that's a big mistake. At least that I see.

I don't know about you, Luke, but I see a lot of people that make assumptions on what the next year is going to look like by what they feel feel like or their situation is right now.

Arnold Stricker
00:33:56

Right, right.

Luke Atchison
00:33:57

Yeah.

Dan Mangus
00:33:57

Yeah.

Luke Atchison
00:33:57

I mean, you're absolutely right. I think, you know, discussing it in a way of leveraging your health and I mean, your health is an asset.

That's a great point to make to people that I think a lot of people overlook is you know, no one has a crystal ball. And so you have to plan for, you know, comfortability. And hey, if you're, if you're comfortable rolling the dice, then, then some people do that.

I would say most people do that. However, a lot of people just really aren't aware, aware of the exposures that they're faced with.

The, the kind of double dipping is how I refer it, where you hit your maximum January 1st, you hit it again and all of a sudden in a maybe a three month span, you've hit in what you would have assumed to be a 24 month, you know, cost cap. And so it's absolutely, you know, a huge factors to look at.

And I think that ties in really with one of the topics we were going to hit on, which is, you know, what questions should people be asking?

You know, I think when it comes to, you know, verifying the knowledge and the integrity of, you know, a Medicare specialist, someone who really knows about the ins and outs, to me, the biggest questions you should be asking, and this is something I focus on with everyone I work with, is not just what Medicare covers, but if I'm hitting on the things that Medicare doesn't cover.

Arnold Stricker
00:35:00

That's an excellent point.

Luke Atchison
00:35:02

Yeah, I mean, I think that that is probably the operative, you know, that ties in exactly with what Dan was saying is that, you know, oh great, there's bells and whistles to it. There's, you know, no premium potentially.

There's, you know, things like dental insurance or what have you and all that stuff's important and it can put money back in your pocket.

But you know, I think that's ties in with the mistakes people make is they, they see the shiny and they want to get attracted to that and they, they aren't really aware of, hey, what is this going to do for me medically? And again, more importantly, what is it not going to do for me medically?

And then that's where you can kind of, you know, get other options to tie in together and really create a big picture, you know, solution to your, your risks and your exposures.

Dan Mangus
00:35:42

You know, Luke, I call that Medicare Part U, you know, with the Alphabet soup.

Arnold Stricker
00:35:48

That's excellent.

Dan Mangus
00:35:48

It's a part you have to pay after all. And it is, it is valid because sometimes it is. The biggest problem I think, is you just don't know what you don't know.

You don't, you don't understand that because you, you know, it is like you were talking about a minute ago, it's confusing, it's overwhelming, it's and so people end up just making a decision to put the fire out in their mind. You know, I just, just get me something, you know, and that's a, that is a kind of a natural thing to do.

But if you will establish and invest in making sure that you get a good advisor and then get a set of questions that are really good questions like Luke was talking about before, write them down and every year ask that same question. You know, has there. Has my plan changed anyway since last year with my new health conditions or medications, should I look at a different plan?

What plan should I use with my health right now? You know, I have money in an hsa. You know, what can I use that for if I'm on Medicare?

You know, every year have this set of questions that you ask and a good advisor and just ask those questions and go in knowing that you probably don't know what is new and different for this year, but that advisor should, if you have a good advisor.

Arnold Stricker
00:37:05

Right. Dan, what are some resources that people can utilize to kind of help educate themselves, help them establish some questions that they can.

They can ask?

Dan Mangus
00:37:14

Okay, well, here's some. I love to use tools that have been created by the cms, which stands for the center for Medicare and Medicaid Services, which oversees Medicare.

They have publications that they create, and then Medicare themselves has publications that they create, and then Social Security also has publications that they create. So here's a few that I think might be helpful. And again, I think you're going to make a way for these to be available.

But one of them is a CMS planning tool for when you're nearing turning circumstances like what you were talking about a minute ago. It's CMS product number 11961. That's CMS product number 11961. And you could just Google that. You could just Google what I had said.

Another one is, which is very common now, individuals that are over 65 and retiring. There's a CMS product number 11963. That is CMS product number 11963.

If you're over 65 and retiring, or if you're just going on to Medicare and want to be kind of introduced to some of the Medicare basics Luke referred to a minute ago to the Medicare and you handbook that a person gets. And that's. That's good. But there's also the introduction to Medicare, which is a CMS product number 119-601-1960.

And I know I'm going to throw a lot of numbers at you, but you know, that's what you're asking for. Here's a couple other tools that a person can use for reference tools. One is to understand Medicare Advantage plans.

Medicare themselves has a Medicare publication 12026. So, so you would go on Medicare.gov up in the search bar, just type in publication 12026 for Medicare supplements.

There is the Medicare publication 02110. That's 02110. And in that particular book, you were talking about all the letters of Medicat plans.

And on page 11, there's a chart of those and it shows what each one of those is and how they cover. You know, plan G is the most common Medicare supplement now that people carry. And so it shows you why that is probably the case.

You know, premium dictates some of that, but also the way that it covers. And then the last one on the Medicaid that was brought up a minute ago, there's a cms publication is MLN006977. That's MLN006977.

And that helps to explain Medicaid a little bit. And then there's a lot of other planning tools.

But, and then the last thing I think I'll mention, and I think, Luke, you probably use this too, but on Medicare.gov when a person's trying to figure out what Medicare is going to cost them and when they should enroll and things, there's a tool called a calculator. It's a cost and eligibility calculator.

So if you go on that Medicare.gov just search, estimate, cost, search estimate, cost, and it pull, it will pull up a calculator for you to be able to key in. And it kind of walks you through your situation and it helps you decide when should you enroll and about how much you should expect for that to be.

Because again, Medicare's premiums are dictated by your income. And so you have to watch for that.

Arnold Stricker
00:41:01

Don't worry folks about that because we'll post that on the podcast page. So, and I'll, yeah, I know that was unlocked. You know, include all those links.

Know that it's good stuff because Social Security comes into play, too, that you can pay for some of your Medicare costs through your Social Security and that might reduce a little of your Social Security benefit. But it's, it's, it's all kind of combined together.

So it's for people going into that, you know, you need to try to go in with your eyes wide open rather than the blinders on because then you'll be really surprised when. When things happened about that. What have we missed? Because there's again, there's so much. I know we have. We've had the previous, but five.

That was, albeit five years ago on the. The Alphabet soup of Medicare. And we're talking kind of getting into some other little nitty gritty things. A lot about part D, too. What.

What have we missed here in our conversation that people will need to remember?

Dan Mangus
00:41:53

Go ahead, Luke.

Luke Atchison
00:41:54

Yeah, I mean, you know, I think that just tying in with everything that Dan just provided in regards to resources, you know, there's so much available to you, and that's. When going through Medicare what I would describe as successfully, you do have to be a little bit of an advocate for yourself.

But I also encourage people, you know, it's not necessarily. Some people don't want to read up on this. I would say probably most people don't want to.

Most people don't want to, you know, have to learn it themselves or go to, you know, online and look at that stuff. I really, from my perspective, encourage people to do that.

But if you don't, again, going back to what we kind of started in the conversation with off, which is identifying local resources, going, you know, finding brokers, for example, you know, people who can represent the information and going prepared with, you know, questions for them, as Dan mentioned, I think the easiest way to get a good list of questions, if you're new to Medicare and never been on it, ask your friends, ask your family, hey, what do you wish you would have known going into things? What's been some curveballs thrown at you since you've joined Medicare?

And go in and vet the individual or call them or however it might be, you know, seek out local resources in terms of like, you know, there are events that go on that are really for seniors, and you could go to that and. And ask the people who are working in the community, because you don't want someone who's fly by night and just gonna disappear. You want that.

That person that can be very relational and, and continue to answer questions. And so I just, you know, that that's something that I think a lot of people, you know, are not really aware of.

A lot of people aren't totally in the know of, oh, there's someone who specializes in Medicare and knows this stuff like the back of their hand, and that means I don't have to know it. Great. That's who I want to work with. So really seeking out those resources and then again, being thorough and making sure.

The individual you're working with is being thorough in their analysis of what your needs are with.

Something that Dan mentioned earlier and I think is, you know, really important is when you're working with a good representative, someone who knows a lot about this, you know, they are not creating need, but they are helping you identify need.

They're making sure that you're aware of, again, some of the costs, but, you know, other moving components and things like, you know, increases to premiums that can happen very regularly, or, you know, network components where an insurance company might have just recently gotten in network with an. With a provider that, you know, hey, maybe there might be some growing pains with that and do you want to possibly be the guinea pig?

So I think it's just there's a lot of, you know, nuanced information, more so than just, oh, I pulled up this piece of paper, it had these plan details. That's what I want to join. So.

Arnold Stricker
00:44:22

Right.

Dan Mangus
00:44:23

Yeah, I want to add to that, too. That, because those are beautiful points, by the way, is that Medicare doesn't function in a bubble.

You know, the other stuff that you have going on in your life, impact that you mentioned, income, that's obviously, you know, something that impacts that person's health. You know, if a person is a veteran, that's a huge impact potentially on Medicare. You know, they may use the VA and think, okay, well, I got the va.

I go to there for all my health. I don't really need Medicare because Medicare is not used at VA facility.

But they, they might, because they might want to pick up a Medicare Advantage plan so they can have the option of going to a doctor somewhere else if they wanted to.

They might want to pick up a prescription drug plan because the drugs are easier to get or maybe less expensive than if they go to the va or they may have Tricare for life, which, you know, with that Medicare is going to layer on top of. And so that's. There's a lot of things like that that you can look at to say, okay, what's my situation? And look at it holistically.

So it is important to make good Medicare decisions, but it's important to make good health care decisions, like I mentioned before. And that can. A lot of different factors can play into that that are beyond the just Medicare.

And so you need to be doing things like if you're a veteran, ask your vco, your veteran service officer every year, are there any changes, any benefits that I'm eligible for, anything that I should know about? And to remember, Luke mentioned some of the things that Medicare doesn't cover, be very aware of that.

Like long term care is something that Medicare does not cover, you know, and so what are you going to do with that? What happens if.

And if you, you're a caregiver, which is a huge amount of our population or caregivers, you know, I'm experiencing that right now myself. You know, if you have that going on, know where those resources are and what your capability is and sit things up ahead of time.

There's ways for you to communicate with Medicare and them to talk to you, but you have to set it up ahead of time. You can't just call and say, oh well I need to know this now.

You know, well, you have to fill this and you have to sit, you have to submit this, do that ahead of time. And if you don't know how to do that, ask those right questions to those advisors. And if those advisors are good advisors, they'll tell you.

If they don't know, you know, that's some, that's one way you can tell if it's a good advisor or not. They'll say, I just don't know, but I'll find out for you.

Arnold Stricker
00:46:45

Right, right.

Dan Mangus
00:46:45

You know, that's completely fine. None of us know it all and we never will.

Mark Langston
00:46:49

Our advisors, are they, are they specific to a carrier? Usually like a seldom anthem?

Dan Mangus
00:46:59

Very, very seldom.

Mark Langston
00:47:00

Yeah, because I think some people think that, oh, okay, it's you're representing Blue Cross, Blue Shield and there are some.

Dan Mangus
00:47:07

Out there that do that. There are some out there that are affiliated with carriers. But it is much rarer than it used to be.

Most of the time an individual is going to be able to compare several different plans and if you run into an advisor and they say, no, this is the only plan that I carry. You know, they're required by CMS to tell you their limited capacity. So they're supposed to. And they can, they have to tell you to be compliant.

Okay, these are the carriers that I carry. These are the carriers I do not represent. But then ask them why there may be good reasons why they don't carry some of the carriers.

You know, they may know something that you don't about that carrier that you need to find out.

Arnold Stricker
00:47:43

Right.

Dan Mangus
00:47:43

So not everything is just mental manipulation or that kind of thing because they don't carry something. It may be a very good reason why they don't.

Luke Atchison
00:47:51

Yeah, absolutely.

And I think, you know, again just in regards to your question, so there are so many, you know, brokers and people who are multifaceted in the companies they work with. Something I tell you know, everyone that I work with all the time is my job is not to represent them, it's to represent you.

Because I mean, at the end of the day, I doesn't bother me what the name of your, the company is on your insurance company.

Mark Langston
00:48:12

Sometimes that's hard for people to believe. I know when I first started looking at it, I go, really? You're representing me and not somebody else here that you're getting a kickback.

But that was hard for me to buy into, I guess, and admit that you really are there to help me navigate through this mess.

Dan Mangus
00:48:30

Well, good advisors are like good physicians, though. And if a physician and if you didn't have to ever pay for a physician to get their help, they would be needing to have compensation from somewhere.

You don't have to pay for a good insurance advisor's help generally because they're compensated by commissions. If those commissions didn't exist, then you'd have to pay for that advice and that would be very costly thing to do.

Just like it is for a lot of different advice that you have to get going to a CPA or going to a physician or things like that. It just happens to be compensated by commission. So yes, that's the compensation structure to avoid.

People have to pay for that, but that doesn't automatically point to that. And there definitely are a few bad apples out there.

But that's the reason why I said make sure you talk to your friends, people who've had experience with that. If you don't have that situation, then do your research.

Have them prove that they have a good track record and that they're affiliated with a good organization and that you're, they're going to be there when you need them. Make them prove that.

Luke Atchison
00:49:34

Absolutely.

And I think the kind of the, the button to put on that too is you are not married to the individual that you got Medicare with when you turned 65 or the insurance company that you got when you turned 65.

It really, you know, you have to identify, you know, are you satisfied with not only your health care costs, but the information available to you and the resources and, you know, your advisor's outlook on things.

And hey, are they willing to, you know, lay it all out for me every year or are they taking the easy road and just telling me to stay put because I've been, you know, satisfied thus far? And so, you know, I don't always encourage people to, oh yeah, shop every year on your, you know, person.

But if, if you feel displeased or feel like you're not getting maybe as much as you want out of the individual you're working with. Absolutely. You can go and find different resources. You are not chained to that individual at all.

And so I encourage anybody who's dissatisfied with either their plan or their individual or both, continue to look around. There are great people in this market that do that. And if you happen to stumble across a bad apple, it's not like you're stuck with them for life.

You can absolutely still figure that out, navigate and find someone else who's really looking out for you.

Arnold Stricker
00:50:40

You know, there are several businesses that when people are approaching retirement age, provide some services for that, what I'm going to call a transition and really help give this information out to their employees who are getting ready to retire so they can, you know, go through this transition process in an easier manner.

I think one, one of the hardest things is that people wait till the last minute or, you know, right before the deadline and then they're scrambling and they don't know what to do and so they just sign up for something. So they, you know, I got something and rather, and maybe they've made a bad decision.

And I really like what you said, Dan, is that, you know, Medicare part you, you know, you have to take care of you.

And maybe it means reading, maybe it means getting online, maybe it means asking uncomfortable questions or having, you know, siblings or friends or your kids help you. You know, it's not like we're not experts at everything.

And so we need to admit, especially in this area because it's kind of from 65 on, what are you going to do? How are you going to best help yourself in that situation? Mark, you got any other questions?

Mark Langston
00:51:52

Well, you mentioned commissions. Sometimes they get commissions. Do those fluctuate between companies? Like I'm going to get a bigger commission with this company.

If I sell you this plan, then I would get from this other company with that plan.

Just a crazy question, I know, but for me as a consumer, I would think I might be, they may be taking me down this road because they're going to get a bigger commission from that other guy.

Dan Mangus
00:52:18

Yeah, there is definitely commission variations. There's pretty much standards on what things are. And so the fluctuation isn't huge generally between some.

There are some plans that were out there like this year. There were some of the drug plans that were non commissionable that were out there that didn't mean that the plan was better.

But here's something to think about if the agent, if the carrier decreases the commission or does away with the commission, they are sending a very loud message that they do not want your business because that's how they distribute product.

So if they are cutting the that off and saying, okay, we're not going to pay commission on this, they are more than likely saying we don't want this product sold because there's a reason why it's not going out in the market. Like for this year, several of the plans were suppressed, which means that they cut the commission off halfway through the year.

Okay, well that, that happened because the carriers were receiving more enrollments than they wanted in that particular marketplace for that plan. They were overloading their network, in other words, and so they were getting business that they really didn't want.

So in answer to your question, yes, that is true that they fluctuate, but generally that's a pretty resounding message that there's a reason why that they aren't wanting more of that business. That happens sometimes with carriers like in the Medicare supplement space. Maybe they're having just tremendous losses.

And so because they, because of that, they start not non commissioning those plans. Well, a person enrolling in one of those plans may realize why that was happening when they start get their premium notices the following year.

Arnold Stricker
00:53:55

Right.

Dan Mangus
00:53:55

And the premiums start going up because they were experiencing losses. So everything is correlated with that. And so yes, that is true, but there's a lot of behind the scenes reasons why that might happen.

Mark Langston
00:54:05

That's good to know.

Arnold Stricker
00:54:06

Yeah, that is, that's good information.

Luke Atchison
00:54:07

Yeah.

And I think just kind of in that vein too, I think that, you know, it's, it's important when your, you know, agent or your broker is explaining to you plan benefits, if they are, if you ask them about, you know, X Company and they don't have a single reason why, maybe that wouldn't be appropriate for you, but they're really steering you. Maybe that's a reason to feel that way.

But you know, if they're able to substantiate and there's reasoning behind it, the background, you know, commissions probably is not at play there. It really is going to be about what's, what's best for you. And as Dan said, there's small variations between each one.

But you know, I know a lot of individuals. You know, last year, for example, one of the higher commissionable products in St.

Louis was, you know, sold at a fairly low level, which is shocking to a lot of people because you'd think that that would be the highest one to Go. But I think just generally speaking, good agents, again, they want their clients to be happy. They want their clients to be on appropriate coverage.

You go sign them up for the highest commission product and it's not appropriate. Good.

You got one year commission and you'll never talk to that client again because they don't want to do anything to, or have anything to do with you.

So, you know, again, it, if you, if you're just letting someone, you know, tell you the, the highlights of a plan and then enrolling in it, there could be some background component.

But if you're doing a full analysis, you know, there's going to be so many reasons to that, that I don't think that the commission is really the, the main or even that continuing factor at all.

Dan Mangus
00:55:27

So.

Mark Langston
00:55:27

Okay, good to know. I think that's good news.

Arnold Stricker
00:55:30

Great information. And Dan and Luke, thanks for coming in today to talk about this important topic.

And it's, it's kind of one, that's an ongoing kind of topic that we probably need to resurrect every once in a while and have you guys on and give us some updates as, as things, you know, go through the federal level and trickle on down through the state level and into our pocketbooks. Not necessarily giving us any money, but taking more out.

Mark Langston
00:55:53

Yeah.

Arnold Stricker
00:55:53

So thank you, Jim.

Mark Langston
00:55:54

That's a whole other show. That's a whole nother show. That's exactly what's happening with that.

Arnold Stricker
00:55:58

Mark, I think we're kind of tight on time here.

Mark Langston
00:56:00

We really are. It's, it's been a great show. It has been great informational and I, I think it's great.

I know I, when I first turned 65, I had someone like you guys that. It took me a while to get that comfort level that you really are looking out for my best interest.

It did take me a while to, like, really, you're not, you know, trying to steer me here, get a bigger commission there, but you're really trying to help me navigate through this, which is. And it's a mess. It really is. I mean, but it's so important, like you said. And I like the part about make decisions when you're healthy.

Yes, I think that's a great advice for me, anyway.

Arnold Stricker
00:56:39

Tough to make them when you're laying in a hospital bed in a coma, you know, and then letting that, you know, somebody else make that. They're kind of confused. Confused too.

Mark Langston
00:56:47

Right.

Arnold Stricker
00:56:47

So good stuff. We will post all of the links that were discussed, all of the information. So go to the podcast page and check that out.

That's all for this hour, folks. We thank you for listening.

If you've enjoyed this episode, you can listen to additional shows@stlntune.com Consider leaving a review on Apple Podcasts, Podchaser, your preferred podcast platform, and even our website. Your feedback helps us reach more listeners and continue to grow.

Want to thank Bob Bertha Self for our theme music co host Mark Langston and our guest Dan Mangus and Luke Acheson. And we thank you for being a part of our community of curious minds. Saint Lucien TUNE is a production of Motif Media Group and the US Radio Network.

Remember to keep seeking, keep learning, walk worthy, and let your light shine. For Saint Lucian Tune, I'm Arnold Stricker.