In this hour, Elder Law and special needs attorney Jim Koewler answers questions about the daunting world of Medicare. Medicare pays 80% of covered costs, and this segment focuses on how you choose to pay for the remaining 20%, clarifying the differences between Medicare Advantage and the supplement program.
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*The following is the output of transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors.
The following podcast is by Mr Jim Koewler, elder law and special needs attorney, helping and protecting those who need long term care. And welcome back everyone. We are talking Medicare this hour on an the answers for elder’s podcast network, with Mr Jim Koewler, who is the attorney and principle of the Koewler law firm in Ohio, the state of Ohio, but Jim has been a long term contact of mind that and friend that I absolutely respect and I’m so thrilled that he is here to answer our questions, especially about the daunting world of Medicare. And Jim, you know you’ve educated us on all the different aspects and things that we need to look for. But I want to take this so this segment and let’s talk a little bit about the whole thing of the difference between the Medicare advantage and the supplement program. Jim, thank you for being here. And how can we decipher the difference? I guess it’s okay, a supplement and if you’ve listened to power segments, some of this is going to be a repeat, but we’re going to assume that you’re coming into this one standing by itself. Okay’s excuse me. Medicare is the federal program that’s available with people who participated in the Medicare the social scurity system, so they paid a Medicare tax, or who didn’t and and pay the buy in to participate in Medicare. Okay. So you have to have Medicare available to you in order to do any else I’m talking about in this segment. So if you’ve got if you were in a state pension program, a teacher, public employee, whatever, and didn’t participate in so security, fine, I’m hoping you also have good insurance coverage through that former employment. If not, do a Medicare buy in. Okay. But once you’re in Medicare, here we go. Medicare covers eighty percent of your healthcare costs, your covered healthcare costs. Dental still not covered real well, and they’re talking about in Congress right now. As you’ve probably heard, vision isn’t covered real well. Vision can be carevered if you have something that triggers a vision medical issue, for example that LACMA, like gluck coma, okay, something like that. Those are medical issues that trigger vision coverage. But if you just need bifocals because you have you know the your eyes are changing shape with age. That’s not covered. What about hearing? What what the hearing? Hearing is not covered. Their talk about covering hearing in funny you should mention hearing because that’s when the big advantage band versus supplement things that is now coming up. But hearing is still not covered, and boy I wish it were. But hearing AIDS are not cheap. So but again, hearing is definitely part of the discussion of what’s going on in Congress right now as they’re doing battle over the infrastructure bill on the one hand, and the budget reconciliation bill that the progressors are pushing. That is really a bunch of social programs, climate change, health coverage, education coverage, early childcare, early early life childcare, that sort of thing. Okay, so it’s on the table as we speak and Barry Sanders is plown on one side and Joe Manson’s plowing on the other and Joe Biden’s trying to pull the to him together. So good luck. Yeah, Hey, you know, if man’s going to make a deals, probably going to be Biden. The at least true of deal, a deal in our favor, let’s put it that way. That’s deal. Is Good for the people. But you can hear my political event. Okay. So with Medicare, medicare recover, medicare itself. That’s the federal program some combination of the part a premium that the federal government pays because you participate in the SOB security system when you were working, the part be premium that you pay each month to your so security hundred forty nine bucks or so during two thousand and twenty one. I expect to change in early two thousand and twenty two. And so between those two Medicare covers eighty percent the what you choose to do about the other twenty percent is up to you and that I hope to be the focus of today’s this particular session. Okay, okay. So what can you do about the twenty percent? Because this way, if you’ve got twenty percent of a doctor visit and maybe that’s nothing, that’s twenty bucks, no big deal. But Hospital. But yet twenty percent of a hospital could be two grand a day. Could piece take two grant a day. Okay, I really have to silent another one. I do what the cost would like at the clinic. Okay. So what you do about the twenty percent is really up to you. Advertisers and insurance companies want you to believe that there is one set of Medicare plans. This is your medicare benefit. Those are advantage plans. If they don’t say the words supplement or Meta gap, they’re trying to sell you in an advantage plan. Okay, let me be clear and use their own metaphor. And advantage plan is an advantage for the insurance company, not for the insured person. Now, why? You’re sixty five, sixty, sixty seven and still healthy. Yeah, and advantage plan looks awesome. It can give you additional benefits. It like transportation to Doctor Appointments, silver sneakers, which is really popular, you know, go to a gym and the advanced plan pays for it. It can give you additional drug benefits because drugs are included an advantage plan. You don’t have it’s not separate like with a supplement. It can even put money back on your soul security, because what they’re doing is waving off the Medicare part B premium that you’re so security would normally pay and putting summer all of that back. Matt means the Entrance Company Advantage Planet is getting paid only the Medicare part a premium from the federal government. So these additional benefits while you’re healthy look great. The thing is, once you’re not healthy, you can’t jump to a real insurance plan like you can Obama care. Okay, on Obamacare, don’t let Obama care is great. Is it perfect? Oh Heavens No. But I do like the ability to say, Oh, I can buy a cheat plan and then if I start to have a health issue, I had just have to tough it out for the rest of the calendar year. Come the next January I can start something different that more fits my new health needs. Okay, you cannot, cannot do that in Medicare and just you are not healthy anymore, you will not be able to pass the under right in the health questions necessary to get a medicare supplement. If you want real coverage, if you want that twenty percent covered and covered, well, okay, an advantage plan will cover everything. They just don’t cover it. Well, as I mentioned in another the metaphor, the similar I’ve used in a different, different segment, having an advantage plan. It will cover you, but it’s like going to sleep with a hand out rather than a blanket. A Medicare supplements like a blanket. That’s the key. So when you are choosing what to do, try to get a medicare supplement. And I will admit, if you are a low income senior you maybe not be able to do that, and I understand. Okay, but if you the quotes are free, at least try to get a quote and see what the cost. But it is the average pre premium for a senior for the differences between an advantage and a supplement. Okay, manage, since an advantage plan can be a zero premier or even putting a hundred forty nine, but under your so security that can be zero or even you get some money back here, but you get lousy coverage. With that. You get coverage, but it’s not good coverage. Okay, generally, when you’re sixty five, a what I would consider a good advantage plan and a supplement are about the same and they stay about the same. The question is as but they do go up, they just go up at roughly the same rate. Okay, if you’re seventy it’s a little more expensive than in your in your at sixty five. If you’re eighty, it’s more expensive to ensure you then you then it was at seventy, etc. Okay, just like you, as you age, your car insurance premium is likely to go up. Well, unless you’re twenty five turning thirty, then it’s likely to go down. But when you’re sixty five, going and moving towards seventy, then your health, your car insurance premum is probably going to go up. Well, your health insurance premium ought to go up to because, let’s face it, your likelihood of meeting healthcare is going up as you age. Okay, so that’s fair. But a good advantage plan, which in my world is a relative term, because I compared to a supplement, there is no good advantage plan. But they go up, the best advantage plans, let’s put it that way. They go up pretty much the same as a supplement as you age. So there’s really not much difference there. The way to save money on our premium is to choose something that really doesn’t cover you well, but then in return you pay a low premium. Supplement does an offer. That supplement is all or nothing. It covers everything or you don’t have a supplement period. So if before you got sick but you’ve already enrolled. Let’s say people have and rolled in an advantage plan and they went a change to a supplement, a care they unable to do that, even if they’re healthy. If they are healthy, they may be able to do so. Okay, it’s if they have a chronic illness or have a history they may not be able to do so. Good Point. Okay, basically back to the old rules of, you know, pre existing condition exactly. So an in the state of Washington, where that does not apply, you might have a better shot. Yes, so move to Washington. But among the in what I assume is the rest of the country, and certainly true here in Ohio, or I live, pre existing conditions can keep you out of a Medicare supplement after a sixty five and, as I mentioned another segment, in that magic window around your sixty fifth birthday you can get a supplement. I don’t care how ill you are. That’s amazing supplement if you can. So here’s the deal. While Suzanne was correct, when you’re relatively young, sixty five, six to six, sixty seven. Whoever thought I’d be saying relatively young about that? But when you’re relatively done, I know it’s kind of crazy that I’ve actually sixty five now. It’s like, I do you so much Medicare, work where you wish. Of the concept of too much income. So you know the Hell is that? So when you’re relatively young and healthy on medicare and a vanity fan looks great, but you can’t jump over to a supplement if you already wish you had one. Yeah, and I think that there’s a certain level of I don’t know what our laws are in the state of Washington. I just known that insurance cannot deny you due to an existing pre existing condition. It doesn’t mean that they can’t charge you more, though, right. So that’s the difference. I think that is really key and all of this and certainly something that we need to take a look at as far as when we’re enrolling. So I’m so glad you’re here with us and we’re going to continue the conversation with for one more segment, I believe. Aren’t? We going to talk a little bit more about Medicare and how best servicess state of Ohio residence? You have a friend to help you navigate long term care while protecting your assets. You can reach Jim at www dot protecting seniorscom or just email him at j Koewler afe. That’s j Koewler AFE at Protecting Seniorscom
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Founder and CEO of Answers for Elders, Inc., Suzanne Newman proclaims often, “Caring for my mom was the hardest thing I ever have done, but it was also my greatest privilege.” Following a career of over 25 years in sales, media, and marketing management, Suzanne Newman found herself on a 6-year journey caring for her mother. Her trials and tribulations as a family caregiver inspired an impassioned life mission outside of the corporate world to revolutionize the journey that so many other American families also find themselves on. In 2009, she became the founder and CEO of Answers for Elders, Inc., subsequently hosting hundreds of radio segments and podcasts, as well as authoring her first book. Suzanne and Answers for Elders, Inc. have spent 14 years, and counting, committed to helping families and seniors along their caregiving journeys by providing education, resources, and support. Each week on the Answers for Elders podcast, Suzanne is joined by vetted professional experts in over 65 categories including Health & Wellness, Life Changes, Living Options, Money, Law, and more. Suzanne lives in Edmonds, Washington with her husband, Keith, and their two doodle dogs, Whidbey and Skagit.
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