Medicare Answers, part 4 with Jim Koewler

*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 everyone back to answers for alders podcast network with the wonderful Jim Koewler from the Koewler Law Firm. And Jim, welcome back. As we’re talking about Medicare, you have been wonderful. Things got me a little weird about but okay, I’ll take it. Well, you know, it’s a it’s a good topic because it’s confusing and, like you said, we’ve got governmental leaders right now arguing about potential changes or, you know, non changes. We never know where it’s going to be and certainly, you know, what we’re talking about today may not even well, it’ll probably probably apply in general, but there will likely in the future be changes as we move forward and in the world, and so that’s the way our system works right. So obviously you’d covered that. Part A, part B, part CE, part D is now we’re up to, and part D is drug coverage. And there’s terms that we have, let’s called like the donut hole. People don’t know what that is. They don’t know a lot of things about you know, when you go get a prescription filled? How does that work with Medicare? And so I’m going to ask you. I know with the affordable care act it changed dramatically for seniors in a good way. So tell us a little bit about part D. Okay, Medicare. Part D is the newest part of Medicare, at least the newest big part of Medicare, and that is for prescription drugs. So if someone has a part c plan and advantage plan, the vast, vast, vast majority of the time they don’t need to worry about a part d because their advantage plan includes practical drugs. And a big part of choosing an advantage plan, and if you’ve listened to other segment, you know I’m not a huge fan. But if you have an advantage plan and you cannot jump to a supplement, there’s nothing you can do about it now. So it’s then choosing the best advantage plan that you can or if you think you can to afford a supplement, fine, choose an advantage plan. But in choosing an advantage plan you’ve got the drug coverage and other stuff in network, out of network. Does this include your doctors, your hospitals and choice etc. But with a Medicare supplement you don’t worry about that. But you have to get a drug plan and the drug plan does have to look at what, how well it covers the drugs that you need, that you take, etc. Okay, now, as costs go, the drug plan by itself, let’s assuming you’re getting a drug plan to go with your Medicare supplement. That’s going to be thirty five warty bucks a month. That’s really chump change compared to your premium for your for your supplement. And it’s only it’s less than the third of your premium just for part B on Medicare. Okay, so don’t let the premium preaky out. Yeah, but it’s the think I said, and add is something like twenty nine dollars a month for my partner. Yeah, my policy exactly. So it’s not horrible. Okay, and I also get over the counter with that too. Yep, and you can find that. You can find drug plans like that. There are probably as many different drug plans and almost as many different drug plans as there are advantage plants, because basically drug plans are advantage plants without the non drug stuff stripped out. It just okay. They created, I think insues create, a prescription plan and then they throw it advantage play on top of it and they package it together so you they can sell it just the drug plan or the advantage plan that includes the drugs. But there are lots and lots of them out there. So if you’re on lipator, for for cholesterol, right and your doctor wants to switch you to cress or, it may not be covered. Okay, so you may want to talk the doctor about switching at the end of the year and switch to a different drug plan that includes press store as December rolls, or you can get a special exception. From when I am you can maybe get a special exception, but I will probably not be approved until January. Been Right, it’s okay. So just may want to tough it out. I’m on a migraine medication and that’s happened to me, but I was able to get a special exception due to my reaction to the generic form. Yeah, but they but they don’t like living giving special exceptions, even in in Medicare and health insurance plans. Before your Medicare they special exceptions, but a you can get. I’m especially for things that don’t have a definite a dozen different drugs available to them, like cholesterol. Okay, blood pressure. So your drug plan, your drug plan of choice, needs to mirror your maintenance drugs. Okay, you’ve got no way to predict one non maintenance strugs you’re going to take. It’s very common when you’re enrolling in Medicare, they’re going to ask you what prescriptions you you take, aren’t they? Now, when you’re in in rolling in either an Advante plan or prescription plan, write your agent will and Medicare by itself. No, they don’t care. It’s the D for your advantage plan, vantage plan, that wants to talk about what you’ve taken, not getting confused with sending it for an advanged plan and sending up for Medicare. You’ve heard me talk about that. Yes, yes, an advertising thing and fall into the advertiser’s trap. Right, right, right. So, yes, they take they will ask you what you need, what you take, what your main instrements are. Okay. Now, if you get a supplement it your broker’s done you a good job, by the way. Okay, keep the supplement of if at all possible, keep the supplement, find a way to afford it and keep it for the rest of your life. But you may need to change drug plans from time to time. Right, since they’re only thirty, thirty, forty bucks a month, you may not find a broker willing to help you because they take time to sort out what’s appropriate for you. If you find a broker that’ll help you, because many of them do considered a service they need to offer, even though don’t get paid much because, remember, they get paid commissions. So on something that’s forty bucks a month, commissions aren’t huge. Okay, I know many states, I think every state, but I won’t guarantee that has a health insurance advisory program or Health Insurance Information Program that can help you pick a drug plan and it’s free. State Department of Insurance or the State Department of aging or something like that. Okay, and here at Ohio’s to Hio State Health Insurance Information Program we call Oh ship, or, depending how you stress that, it can sound really fine. Oh ship the but I’m a big Fan. Okay, at this time of year we’re taping in October, which is when the annual enrollment comes up, when people many plans, change their their drug plans. If you’re on a supplement. Don’t change your supplement. Okay, don’t change your supplement, don’t drop your supplement. Okay, but this is when people are looking at their advantage plans and their prescription plan. Do I need to change? And the drugs you take may change. For that matter, your plan may change and not be the same, not provide the same drug coverage as it did for two thousand and twenty two as it does during two thousand and twenty one. So you’ve got to look at all those things. Okay. But if you don’t, if you’re not getting an advantage plan, if you get an advantage planet, broker will help you out because they get paid a bunch because the name makes a lot. But if you’re just getting a drug plan, which is again what I suggest supplement, keep it. Change your drug plan is necessary. If you’re just getting a drug plan, you may not attract a broker’s attention because they’re simply not going to be paid enough. See if your state has these advisors and they usually show up at least in a highly show up at senior centers. They not, may not be there for nine months. That’s different than broker. That that represents multi insurances. That is not an advisory. Make sure that they are. You know what you know, yeah, you’re not affiliated with companies, is that they are paid by the state. Yeah, well, paid by the local department of Aging, are paid by the county. Okay, because there are you, there’s out there. You and not try to sell you something, right, because there’s brokers out there that may represent several companies. Right, they’re they’re going to want to still sell you something. Oh yeah, and then when a steer you into the one that makes them the most money, even if it’s not a great fit. Okay, so I need to go find somebody who does it for free. Your state probably offers that through the Insurance Department or the aging department. Okay, the look for these people check. I had to do this fron of my father in law. Okay, my father in law’s on a supplement. My motherinlaw got offers reasons I cannot explain, but my father was law supplement. He had to change, he had to start taking a new drug. I just I made a phone call to the senior center near him and said, you guys have a no ship representative. Remember that’s what we call it here in Ohio. Yeah, Oh, yeah, they’ll command and here’s the dates. I gave him the phone number the person to ask for. They can take care of it. They don’t get paid a commission, they get paid a salary. That’s perfect. Oh, they’re great. They’re great. Way To find our plan that fits you without pressing you into buying anything in particular. Okay, okay, a drug plan is like obamacare. You can change that from one year to the next and they can’t turn you down. least my experiences, they can’t turn you down because you’re taking a different drug now. Right, somebody will fit you. Okay, and if you’re not tied to a particular advantage plan, therefore you’re not tied into a particular advantage of Plan Insurance Company, then you have the whole gamut of drug plans open to you. Right, take advantage of it. Go. So here’s my other question. Married couples. Let’s say that one plan fits one person better the other. Is it okay for them to have separate or is it better to find one that they can compromise on one on one company? These are drugs for health. Don’t compromise. Get the one that fits your best okay. So you might your spouse might have a completely different insurance company. There’s no advantages to coming in as a couple and doing only advantage would be you only have to send a check to one place or two checks to one place. That’s not the premium is individual. Yeah, the advantage is on the convenient side of paying, not on the health coverage. Okay, I’m not on the pricing side. Okay, okay, at thirty bucks a month, how much a break can they give you? No, I agree. I just was wanting to make sure over overall, whether it’s a supplement or an advantage program or part d you know, if the spouse is different. Obviously we’re talking about specific medications. That’s one thing. Oh yeah, I want to determine. So that’s why I asked. Yep, yes, and if you want like Suzanne has, if you want something that adds in other benefits, like over the counter, go for it. Absolutely. I think it was like that was like a no brainer. Yeah to me. Well then it’s perfect for me if you but you could also get separate over the counter coverage, separate from the drug plan. HMM. You can get cancer coverage, you can get Rehab Coverage. So, once you get past the Medicare plus a supplement, plus a drug plan? HMM, or if you do it the way I’m not a huge fan of, sign it for Medicare and then get an advantage plan with craps around everything. Once you’re past that, any other coverage you want you can get, okay, if you’re for example, one of the big differences between an advantage plan. I realize we’re off drug cards right now, but one of the big advantages, one of the big differences between advantage plan and a supplement is how well they cover rehab. Vantage plan not so well if you cannot jump to a medicare supplement because you’re not going to get under dad physical therapy and it was all paid for. But if you are stuck in advantage planning, you and I’m talking about Inpatient Nursing Home Rehab. Yeah, okay, well, that’s huge. Yeah, enormous. Cost even eleven grand a month just for room and board the and that’s around here. I can’t imagine when it’s like a New York City. Okay, so if you can buy separate nursing home insurance, maybe that’ll help fill the gap. To get your cloe take your advantage plan closer to a supplement. Okay, so there are other things out there that you can get. No, they’re not going to be free. Now remember the point you get past the basics of this in surance supplement or advantage plan, drug card or its roll in your advantage plan and you’ve got Medicare or you’ve got your pension back, you know, your teachers insurance, your public employees insurance. Once you get past those basics, anything else you choose to get, you choose it based on whether it helps you sleep at night. Yeah, would you? Do you want the coverage so you can sleep or do you want to not pay the costs so you can see? I don’t care what you choose, but that’s how I suggest you look at it. Well, this has been a really informative topic that we talked about and thank you so much for going through the story of Medicare. It’s a lot to take in and to all of your listeners, I hope you’ve enjoyed this four part segment and Jim will be back with this with a lot more topics on law and other situations where we need people like him to help us. Thanks again, Jim. Thank you, 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