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Minute #5
Minute
#35
Minute
#65
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Brian Therrien:
Today we have a special guest, John Connor’s with us to talk all
about health insurance, your options, help you understand them, help you
maximize your coverage. John
thanks for joining us. John Connor:
Thanks. Good to be here. Brian Therrien: Great.
Great. And I know, at the
top of the call, we had, before we started today, we had a lot of questions
that were sent in, so, for you participants that are out there, again, thank
you for joining. The agenda and
what we’re going to cover today is up on the screen.
We’re going to cover pretty much everything, A-Z, healthcare that we
can from Medicare. We’re going
to talk even about some donuts today. Medigap
policies what your options are and what you can do to find out if you’re
properly covered, so. Just a
little housekeeping for everybody that’s attending today.
This call is being recorded, so if you want to listen to the replay,
something you missed, you’ll be able to hear that back.
In addition to that, if you want to ask questions at the end of the
call, hopefully we will have time to cover some of the questions.
Right now everybody is muted, so you’ll be able to hear us, but we
cannot hear you. What you can do
right now, if you want to start submitted a question, is there’s a chat
feature on the console of the software that you’re using to log in.
You can type in your question, but later on we will unmute the lines,
individually, so that you can ask a question.
So, let’s get started. You
know what I want to do, John, before we get started is just talk a little bit
about the work that you do with Transition Assist.
You’re down outside the Boston area, one of my favourite cities, and
your company, Transition Assist, you help people that are disabled, and other
Americans, understand what their options are from changing their health
insurance from whatever situation they might be in, you know, in their life.
So, the whole objective, my understanding, what you folks have become
known for is really reducing the intimidations that people get when they’re
making certain changes and options. I
know that, for me, as a small business person healthcare is just a monstrosity
of a concern and if you throw in an illness of somebody being disabled, it’s
even more intense. So, great work
that you’re doing. So, we’re
going to talk more about that later if we can.
More about what Transition Assist does.
You’ve been doing this for awhile, haven’t ya?
Eleven something years you’ve been working in the industry? John Connor:
Yes. Mostly with health
insurance for folks into retirement. Brian Therrien: Um-hum. John Connor:
That’s our specialty. Brian Therrien: Great.
Great. You know, I was
looking at some of the work that you’ve done.
You’ve put in some initiatives for some pretty impressive companies:
Lockheed Martin, Sherwin-Williams, Haliburton, the ever controversial
Haliburton company, John Deere. John Connor:
I can tell you with Haliburton I’ve only dealt with the employees.
I didn’t do much with the executive or the board of directors. Brian Therrien: Okay.
Well, that’s a good, safe comment. John Connor:
Yeah. Brian Therrien: And others like HP Fuller,
so, these are some really...some premiere companies that are out there, so,
without further adieu and in respect of the time that we have, let’s start
with the basics. You know, when
people are out there in the working world, they get sick, they no longer can
work anymore. One of the main
reasons that they go and consider applying for disability is that they can get
their Medicare coverage. So, I’d
like to start with the basic ABCs, if you will, of Medicare.
If you could walk us through the different parts and give us a brief
overview, so that people that are considering disability or even maybe a
refresher for those who are on it can get a good grasp of what the
expectations are. John Connor: Great.
I think it is a very intimidating prospect to learn about Medicare.
It’s a fabulous program that’s available to all folks over 65 and
those folks who are under 65 and disabled.
But, to get the most out of it, you have to know how it works and what
options you have. So, everyone’s
heard of Medicare A, B, C, and D, but how do they...what does each one mean?
So, Part A is the first one alphabetically, first one to talk about. John Connor: It’s actually hospital
insurance. It’s the insurance
that covers folks if they’re in a hospital for an acute stay.
These are the major costs, unpredicted costs that people will face.
All folks are eligible for Part A and, actually, your premium is paid
for you if you’ve worked for 40 quarters.
So, if you’ve had 10 years of working experience, once you become
Medicare eligible, there is no premium for Part A.
It’s part of the dues you paid as a working adult. Brian Therrien: Can I pause you there? John Connor: Sure. Brian Therrien: I believe the answer, I know
the answer to this, but when people are looking at qualifying for their Social
Security disability benefits, one of the key criteria is they need to have
enough work credits and the general question is or, you know, screening
criteria is they would of needed to work 50% or more of the last 10 years.
So, would that same rule apply for their Medicare? John Connor: Well, to get the premium
paid, you do have to work, I believe it’s full-time for 40 quarters. Brian Therrien: Okay. John Connor: If you do not work or have
not been able to work for that period of time, Medicare Part A is still
available, but there’s a premium attached.
And that premium can run anywhere from about $233 a month to $423 a
month, depending on the situation. And
each person should check with Social Security to find out what is their
criteria, how much have they been able to put into their Medicare bank, and
what will their eligibility premium responsibilities be once they become
eligible for Part A. Brian Therrien: Okay.
So, the key is if you’ve worked 40 quarters or more, you’re safe?
If you haven’t, then there’s some type of premium that will be
tagged on to A? John Connor: Exactly. Brian Therrien: Okay.
Great. John Connor: And always check with Social
Security. We pay those folks out
of our tax dollars, they’re there to help us, and it’s never a bad idea to
give them a call and find out what is their personal eligibility standpoint. Brian Therrien: Is that included on those
statements that people receive? They
seem to receive every year around their birthday? John Connor: The green ones? Brian Therrien: Yeah. John Connor: With the green envelope?
Yes. The number is in there
to...the numbers are in there to tell you what your eligibility is, so you can
always refer to that that form, as well. Brian Therrien: Super.
Okay. Great. John Connor: One of the things to note
about Part A is it does cover skilled nursing and that’s kind of a confusing
issue, because skilled nursing can often be confused with custodial nursing
and that’s at-home care or nursing home care.
Part A will actually cover you if there’s a skilled nursing
situation. For example, changing
an IV, changing a dressing. What
it does not cover are things like helping you get out of bed, changing,
dressing, bathing. That’s
considered custodial care and while there is some provision for that, under
Medicare, it is important to draw the distinction between the two that skilled
care is covered at a much higher level than custodial care. Brian Therrien: Okay.
Good to understand. A lot
of clarifications are always helpful for this. John Connor: You know, a lot of the stuff
I’m speaking of are questions we get from people all the time about what the
difference between the two is. Brian Therrien: Okay. John Connor: So, that’s your Part A.
Now Part A comes with a deductible.
Basically, there’s a...just a little over $1,000 deductible.
So, even though you have insurance under Part A, if you were admitted
to a hospital, the first $1,024 is the patient’s responsibility.
Now, we can talk a little bit about duel eligibility and we’ll
probably get into that a little bit later, so if there’s a Medicaid or a
state health situation involved, then some of that may be covered, but under
normal circumstances, there is a deductible, whether you pay it or someone
pays it on your behalf, of $1,024. Brian Therrien: That’s a peculiar number,
but I’m sure there’s some logic behind it. John Connor: You
know, I think when they came out with Medicare in the 60s, the number was
probably nice and round and it wound up getting escalated by a few percentage
points every year, so it’s always a squirrely number, but it does increase a
bit every year. So, that, in a
nutshell, is your Part A. Now,
most folks, at the same time that they become eligible for Part A, become
eligible for Part B. B is the
outpatient insurance. This is
things like doctor visits, physical therapy, durable medical equipment, and
anything that is covered outside of an inpatient stay in a hospital.
Now, there’s always a premium to Part B, even if you’ve worked your
40 quarters. Part B, this year, is
$96.40 per month. Now, people with
higher incomes will actually pay a graded escalation to that, so it can be
anywhere from $122 to $238 a month, but most of us that are Medicare eligible
see a $98 or $96.40 deduction from the Social Security check on a monthly
basis to pay that Part B premium. Brian Therrien: So, if somebody’s Social
Security check is $1,000, they’re going to see the $96.40 taken out of it
automatically? John Connor: Every month, yes.
Once they’re Medicare eligible. Brian Therrien: Okay. John Connor: It is possible to decline
Part B. It’s never a good idea.
We have clients who mistakenly decline Part B and then found themselves
in a position where they couldn’t have any outpatient hospital...any
outpatient insurance for six months. So,
when it’s available, it’s always a good idea to get it. Brian Therrien: Okay. John Connor: Part B also comes with a
deductible. It’s $135 and,
again, that is your responsibility before Medicare kicks in.
Now, when you take Part A and Part B, together, what you really have is
an 80/20 insurance policy. Medicare
pays 80 percent, the individual pays 20% and you’ll always hear the
disclaimer at the end, for Medicare covered services.
So, it’s important to make sure that services that are being given
and accepted are actually Medicare-covered services and that’s a legitimate
question. Anybody should be able
to ask their provider to make sure that Medicare will pick up their part of
the tab. Brian Therrien: Good.
Good. John Connor: Okay?
Now, let’s add some more letters to it.
I’m going to skip Part C for a second and go right to Part D. Brian Therrien: Okay.
John Connor: D came out in 2006 and that
is also known as the drug plan. This
was instituted by the Medicare Modernization Act of 2003.
The first plans came out in 2006 and it is a fairly complex insurance
plan for prescription drugs. While
there are dozens and dozens of plans in every area, it’s important to know
how they’re basically set up and they’re all set up really on the same
chassis, with a few modifications because this is private insurance, Part D
is, sold by private insurance company, so they’re always looking for an
angle how to make our plan more attractive than someone else’s?
But, essentially, this is how they’re built.
A person pays a monthly premium. May
or may not pay a deductible. And
then pay roughly 25% of the cost of prescriptions until the cost of those
prescriptions reaches $2,700. Once
those prescriptions reach $2,700, the person, individual, pays 100% of all the
cost of the drugs until they reach $4,350.
Once they reach $4,350, the insurance plan pays 95%.
What they call catastrophic coverage.
So, each plan really has three tiers.
There’s a 25% up to $2,700, there’s 100% up to $4,350, and then
there’s 5% that you pay from $4,350 on to the end of the year and then it
resets every year. Brian Therrien: I’ve got a lot of
questions, but here’s one at this time.
Is there some general rules of the game that all these private
insurance companies have to play by, which is the 25% coverage up to $2,700? John Connor: There...well, the rules that
they all have to play by is the $2,700 to the $4,350. Brian Therrien: Okay. John Connor: That 25% that I mentioned,
it might...it’s done in the form of co-pays for different tiers of drugs.
Most drugs are classified into four or, potentially, five tiers.
Tier 1 is your generics. Things
like simvastatin and omeprazole, the generic versions of some of the brand
name drugs that are out there, antibiotics.
A good hint for the generics are when you go to Wal*Mart and see those
$4.00 drugs, those are the generics. Brian Therrien: Um-hum.
Um-hum. John Connor: Then there’s Tier 2 and
Tier 3. They change by companies.
So, Aetna might call Lipitor, for example, Tier 2, and AARP might call
it Tier 3. But, they’re the
brand name drugs that are fairly proprietary and a little more expensive. Brian Therrien: So, John, who sets the rules
to the game for this? John Connor: Well, CMS set the basic
structure out, but then they let each individual company have the freedom to
make their own rules within the parameters of this $2,700 to $4,350. Brian Therrien: And C...what was that again?
C what? John Connor: CMS.
More alphabets. More
letters for our alphabet soup here. CMS
is the Center for Medicare and Medicaid Services.
We can refer to them as the Medicare folks. Brian Therrien: Okay. John Connor: It’s part of...it’s part
of the US Government’s Health and Human Services Division and CMS is kind of
the police. They’re the folks
that set the rules. They monitor
all of the insurance companies out there making sure that everybody plays by
the rules. And they’re also the
place to go if you have an issue with an insurance company in the Medicare
world. They’re a great place to
go and let them know what’s going on, because they are there to watch out
for the individual. Brian Therrien: So, they’re accessible? John Connor: Yes. Brian Therrien: So, okay, how many
companies, roughly, participate in Part D as far as options? John Connor: You might see...depending on
where you live, you might see 15 or 20 different companies offering Part D
plans. Brian Therrien: God. John Connor: It’s...it can be awfully
confusing and it’s hard to find out which one is good and which one is bad. Brian Therrien: Um-hum. John Connor: Medicare, actually, has a
customer feedback on their www.medicare.gov
website, which will tell people
what the feedback has been from each company.
Whether it’s been on payment of claims, on availability of
prescriptions, on delivery of prescriptions via mail order or any other
vehicle that they...they will tell you how folks like you have given feedback
on the plans that they have. Brian Therrien: That’s kind of like your
power seller rating on e-bay, right? John Connor: That’s it. Brian Therrien: That’s awesome. John Connor: You want to have a good one. Brian Therrien: Wow.
Wow. Perhaps we can include
that as a resource at the end of this for the folks to do a little
reconnaissance work. John Connor: Great idea. Brian Therrien: Yeah.
Yeah. If you can share that
with me, that would be great. John Connor: Okay. Brian Therrien: Well good.
This is a good starting point. So,
we’ve covered A, B, D. Is there
any any other general information for D we can...I’ve got a few specific
questions, but is there... John Connor: Sure.
That’s really...I mean that’s the general part of D.
We can...D can take...you can take all day explaining the differences
of D, but to start with this...this picture of, okay, why is it what it is?
How is it set up that way? To
know the number of $2,700 to $4,350. To
understand what that means. Then
we can get into more specific questions. It’s
easy to go back to the original palate and say, well this is where it fits in. Brian Therrien: Okay.
Alright. So, want to cover
C now? John Connor: Sure. Brian Therrien: Okay. John Connor: Medicare Part C is also
known as Medicare Advantage. And
we’ve heard a lot about Medicare Advantage in the last couple of years.
It’s fairly...it’s a fairly new concept.
It’s actually private insurance companies that are paid by Medicare
to administer the care for individuals. So,
for example, if you decided to go with a Medicare Advantage Plan with, for
lack of a better term, Aetna, Medicare will actually pay the insurance company
$800 to $1,000 per month for that coverage.
Now, the insurance company has agreed that the plan that they offer
under Medicare Advantage has to be at least as good as Medicare.
It has to cover things at least as good as Medicare did.
Now, what the insurance company will also do is they may add an
additional premium of anywhere from $20 to $40 to $60 per month and in return,
they may be ancillary benefits that are included in the plan.
Things that Medicare doesn’t cover.
Like an eye exam for nearsighted/farsighted, like some dental coverage,
like hearing aid coverage. All
things that Medicare does not pay for, but the private insurance company,
again, because they want to compete in the open market, are going to try to
offer things that are...that consumers want. Brian Therrien: So, C is an optional? John Connor: C is optional.
What’s important to know about C is if you decide to go with a
Medicare Part C or Medicare Advantage Plan, you actually take your red, white,
and blue Medicare card and put it in the sock drawer, because you’re not
going to use it. You’re going to
use the private company’s insurance card, whoever that company may be.
And they are in charge of paying all your claims.
Now, it doesn’t mean that you’re out of Medicare and some people
make that that leap. They think
that because I don’t use my red, white, and blue card anymore, I’m not in
Medicare. Remember I talked about
CMS? Brian Therrien: Um-hum. John Connor: They’re the police?
They’re in charge of the Medicare Advantage Plans.
If something isn’t part of...if something doesn’t smell right in a
Medicare Advantage Plan, you can always go to CMS and have them help
straighten it out. You have...you
do not forfeit your rights as a Medicare recipient if you take a Medicare
Advantage Plan. Brian Therrien: Okay.
Can you give me an example of why somebody might choose a plan like
this? John Connor: Well, most Medicare
Advantage Plans are network plans. Meaning
the private insurance companies capitalize on their their medical networks for
the under 65 market and they use those networks for these Medicare Advantage
Plans. So, if your doctors are in
a network that is covered by a Medicare Advantage Plan, it’s a very cost
effective way to receive healthcare. In
fact, many...most Medicare Advantage Plans include that Part D prescription
drug coverage in the plan. So,
rather than having your Medicare and your Part D as two separate things, you
would have one Medicare Advantage Plan that covers all your health, all your
prescription drugs, for a fairly low premium. Brian Therrien: Interesting. John Connor: Yeah. Brian Therrien: So, the key is if you have
a...if your doctors are in the network, that would be really the first thing
to look at. There could be a
possible...you could get a better plan for comparable money? John Connor: That’s exactly what you
could get, but what’s most important is your doctors have to be in the
network. Brian Therrien: Um-hum. John Connor: We’ve heard from insurance
companies that said, well, just tell them to change their doctor.
Doesn’t really fly when people have been seeing the same doctor for
years. You don’t just up and
change. Brian Therrien: Yes.
Yep. John Connor: That usually is first and
foremost the primary driver for folks. I
want my doctor. So, if your
doctor’s in the network, Medicare Advantage Plan can be a great thing. Brian Therrien: Um-hum. John Connor: If not, then there could be
some other alternatives. Brian Therrien: Okay.
Interesting. Good.
Great overview. Here’s
what I’d like to cover now. I
want to walk through the process of, for our audience that’s out there, as I
mentioned to you there are folks that are listening today that are maybe still
working and considering, at some point in time, either considering or having
to file for disability and then they go through that process, so these options
may be down the road. But, I want
to kind of walk through the path that somebody has as they consider this
process and have a few questions along the way.
Okay? So, let’s start
this. From the day...from the day
that somebody applies for disability and they’re out of work, then they
typically, in the ideal world, would be able to get some type of private
insurance, a Cobra plan that they can stay on for awhile, right? John Connor: Correct. Brian Therrien: Okay.
So, if somebody’s not on a Cobra plan at this stage, the other
options...there really aren’t any other options; is that correct? John Connor: It’s been hard to find
alternatives to Cobra for folks who are in a disability situation, because
private insurance companies have the right to say no and not take people. Brian Therrien: Okay.
Now, for the audience out there, we’ve done an extensive amount of
work in helping people that are uninsured find treatment options and there are
options out there, low-cost, no-cost treatment options and sliding scales and
at the bottom of this call we will put a link that will say, low-cost, no-cost
treatment options, which is some work we did just maybe eight or nine months
ago. In the message here, for the
audience, if you are going through the disability approval process, it is
really critical that you pursue treatment, because Social Security, in order
for you to get your benefits so that you can get approved so that you can get
Medicare, wants to see a consistent behaviour of treatment.
So, even if you don’t have health insurance, I know the question is,
what am I going to do? How am I
going to pay for it? How am I
going to make it work? You have to
work on those options and they are out there.
So, stay tuned into the resources at the bottom of this page for those
that are listening. Okay.
So, somebody’s out of work. Cobra
or uninsured, follow the resources that we have, then they go through the
disability approval process, hopefully they have followed our system and
they’re not hung up for three to four years and they get through in anywhere
from 3 to 18 months, is what we’ve been able to get our people through and
approved for by following our mini course, and they get approved.
So, somebody gets that award letter that they are approved for Social
Security disability. They let us
know, we all get up from our computers and we dance here and celebrate for
them and, now, they’ve got to wait, right? John Connor: Exactly.
They have to wait 24 months. Brian Therrien: Okay.
So, still during that 24 months the options are still Cobra or the
other treatment options that we had outlined for them, right? John Connor: Right. Brian Therrien: Right. John Connor: Correct. Brian Therrien: Now, okay.
So, after 24 months, they become eligible.
That’s when they can come back through and they can take a look and
understand all the options that we’re going through today and explore what
their possibilities are. Okay.
So, that covers the timeline bringing somebody up to the decision
process of becoming Medicare eligible. Is
that the right lingo? John Connor: Correct. Brian Therrien: Okay.
Good. So, then, we’ve
gone through the general parts. What...what
are some of the...what are some of the first steps or options that people
should consider when they, you know, and when should they consider them?
When should they start looking at their Medicare options and what are
some of the questions they should ask? John Connor: Sure.
That’s a good point. They
can start looking at their Medicare options up to 4 even 5 months before that
eligibility date. They can apply
up to 90 days before that eligibility date.
That’s when they have what is called a special election period or
initial election period for Medicare. It
allows them that ability to go off the end of the year cycle that most folks
are on or that they’ll be on eventually because their Medicare resets every
year. But, they can...up to 90
days before their Medicare eligibility date, start looking at plans.
Start looking at strategies and make sure that their A and B is going
to be set up correctly for that eligibility date and they’re going to be
okay. Brian Therrien: Okay.
Well, that’s good. You
know, there’s one thing that I...that I just thought of that I neglected to
mention in our prior part for those that are going through the application and
the waiting process, which is Medicaid. In
certain states it’s friendlier than others for Medicaid and, you know,
Medicaid is a need based program where you can get treatment and I guess my
questions...I’ll get on to my question in a minute, but for folks that
have...are...have low to no assets. If
it’s $3,000 or $2,000 as an individual of assets that are in that range,
then certainly look into Medicaid, which will allow you to get some treatment
and could bridge the gap for you. So,
I guess my question is, John, are there...are there significant similarities
between Medicaid and Medicare? Are
the same deal? John Connor: No.
They’re actually...they’re very separate.
They often work together in situations and people will hear the term
“dual eligible” when talking about the two situations.
That they’re Medicare and Medicaid eligible they’re considered
dual. We have a lot of folks that
will call us thinking that they are the same, but Medicare is an entitled
insurance for everybody. They have
a right to it. Medicaid, as I just
said, is a need-based service, which handles not only Medicare situations, but
it also covers long-term care as well. So,
Medicaid, if someone is need based, can access that benefit for significant
long-term care, say, which would be nursing homes or even at-home care and
other situations. Brian Therrien: Okay.
Good. Good.
Alright, as far as the options, we’ve done a good job of outlining
them. There’s one thing that
seem to have come up a lot, one of the questions or pitfalls, and it’s
really interesting the lingo that goes on in the industry out there.
There’s a term called the donut hole and this particular donut
doesn’t seem to be too tasty. So,
we talked about it briefly, but can we zero in on that for a minute and maybe
you can give people some advice or guidance in how they might be able to avoid
that because that really is a big challenge for folks on Medicare from my
understanding. John Connor: It is a tremendous
challenge, because...and I’ll go back to my...the illustration I have where
you pay...remember I said you pay 25% roughly, depending on the plan, up to
$2,700. Brian Therrien: This is Part D, right? John Connor: This is via Part D, so all
your prescriptions, you pay 25% up to the cost of your prescriptions.
Now, what that means is, it’s not the 20...it’s not the money that
just you pay, but the total cost of that prescription.
For example, Lipitor might be $200 per month and you might pay $50, but
when it goes into the calculations, the $200 goes in and it says that the
individual paid $50, the insurance company $150 and those two numbers,
together, go side-by-side up until the individual has used $2,700 worth of
prescriptions. Brian Therrien: Well, John, there’s some
people out there on $1,000 of prescriptions a month.
I know it. John Connor: Absolutely.
Well, I’ll tell you what, this is where you start the donut hole,
when you get into that, when you...once you spent the $2,750.
Now, for someone who spends $1,000 a month, by the time they get
through the donut hole... Brian Therrien: Let’s define the donut
hole here. John Connor: Okay.
So, you go into the donut hole at $2,700. Brian Therrien: Okay. John Connor: Now, keep in mind that I’m
using rough numbers here, you’ve paid $700, the insurance company’s paid
$2,000, just using that as a rough number, on the $2,700.
Keep in mind now, you have to pay not from $2,700 to $4,350, but from
the $700 you paid to the $4,350. Your
cost, individual, has to reach $4,350 until you come out of the donut hole. Brian Therrien: Wow.
So... John Connor: And you pay 100% from that
$2,700 to the $4,350. It’s not
an easy concept to understand. It’s
not intuitive. They’re using two
different calculations to find out when you go in and when you come out. Brian Therrien: So, that’s $1,500-$1,600,
right, out of pocket, my simple math? John Connor: Yeah. Brian Therrien: Yeah. John Connor: Well, even if you forget
about...forget about what the insurance companies paid, to come out of a donut
hole, and individual has to spend $4,350. Brian Therrien: Oh, okay. Audience Member: Yep.
That’s how you come out. Now,
basically, what it says is that the insurance company will assist you along
the way with their contributions to stretch that time that you have to pay the
$4,300 out, they’ll be covering some of it, but you have to spend $4,350.
Now, once you do spend $4,350, you only pay 5% for the rest of the
year. So, on $1,000 worth of
prescriptions, you’d spend $50 a month for the rest of the year. Brian Therrien: So, you know, an average
disability check is like $1,000 a month. So,
then... John Connor: Well, there’s...yeah,
there’s potential relief. There’s
always the option of writing to the or contacting the drug companies. Brian Therrien: Um-hum. John Connor: There
may be...there are what they call duel eligible plans.
There are Hard D plans that will acceptance assistance from Medicaid
contribution. So, if there’s a
need based, there’s potential relief there. Brian Therrien: Okay.
Encouraging. Good. John Connor: But, the folks...the folks
that take the very expensive drugs, my wife, for example, takes a $1,600 a
month prescription, so the donut hole would have really no effect on her
because at $20,000, once we’ve paid the $4,350, we’re only paying 5% for
the rest of the year. Brian Therrien: Um-hum. John Connor: But, where we find people
that will see themselves in trouble are folks that are coming from an employer
plan, where the employer plan, it might have been a $20 co-pay for everything
or a very low tiered co-pays and there is no donut hole.
These folks find themselves what they used to spend $800-$1,000 for now
cost them $3,000-$4,000 a year. Brian Therrien: Um-hum. John Connor: And that’s what people
need to be aware of and watch for, is the sudden change in what they thought
they were going to be paying based on something they already had. Brian Therrien: Um-hum.
Um-hum. Okay.
Good explanation. Solid.
Excellent. John Connor: Well, we do this a lot. Brian Therrien: Yeah.
Alright. So, let’s talk
about a supplement. You know, what
it is, how it may be able to help smooth out some of these...it sounds like to
me that everybody has their own certain need because of their condition and
their prescriptions and, so, you can take a look at it and there’s some
overages, then is that where a plan like, you know, like a supplement would
come in? John Connor: Sure.
I’ll give you a quick, kind of overview of what a Medicare supplement
is and how it’s different from the alphabet soup of A, B, C, and D. Brian Therrien: Okay. John Connor: Because it’s really none
of them. Medicare supplement is
private insurance that is policed by the folks at CMS, Medicare folks, so they
oversee it, but it’s run by private insurance companies and there’s no
contribution from Medicare to the supplement companies.
When I talked earlier about the 80/20 co-insurance, you pay 20% of all
your Medicare costs... Brian Therrien: Um-hum. John Connor: ...then you pay your
deductibles, whether it’s $1,024 for Part A or $135 for Part B, these
Medicare Supplement Plans are designed to cover all or a portion of those
deductibles and those co-payments. So,
you might find, for example, a Medicare Supplement Plan that you’ll pay a
monthly premium and you’ll see no other co-insurance or deductibles for your
inpatient or outpatient costs. Doesn’t
include Part D, but for the health portion, for the A and B, it covers
everything, all the co-payments, that would be subject to a Part A or B
service. Brian Therrien: Okay.
So... John Connor: It’s essentially like
prepay...it’s essentially like prepaying for your health.
So, if you know that there’s or if you have an inclination that your
costs are going to the 20% that you normally would pay is higher than the
premium, then you pay a monthly premium and all your costs are taken care of. Brian Therrien: Alright.
Now, is a supplement commonly used with somebody that’s on A and B
and my next question would be would somebody that’s on Medicare Advantage
Part C also be a possible candidate for a supplement? John Connor: A person who’s Part C
would not be. Really what
you have is, when you’re A and B eligible, you’ve got a decision to make.
You could take three paths. One,
is nothing at all. I’m going to
have A and B, I’m going to pay my deductible, I’m going to pay my 20%
co-insurance. That’s one
decision. Brian Therrien: Okay. John Connor: The other is, I’m going to
go for Medicare Part C. I’m
going to put my A and B together, I’m going to have a private insurance
company take care of my plan, they’re going to get paid by Medicare to
oversee me, I’m going to use one card, my XYZ insurance company card, and
I’m going to show that. Brian Therrien: And I still get to use my
doctor because, ideally, he’s in the network. John Connor: He’s in the network. Brian Therrien: Okay. John Connor: That’s another choice.
The last choice is, I’m going to take a Medicare Supplement Plan and
that is independent of choosing Part C. You
cannot have a Medicare Advantage and a Medicare Supplement Plan.
The two have to be independent. With
a Medicare Supplement Plan, you don’t put your red, white, and blue card
away. When you go to the doctor,
you show your red, white, and blue card and you show your Medicare Supplement
card. And the doctor’s office
sends 80% of the bill to Medicare and 20% of the bill to whatever Medicare
Supplement Plan you have. Brian Therrien: That’s...that
clarifies it, for me anyway. John Connor: Okay.
Now, an important thing about Medicare Supplement is there’s no
prescription drug coverage. So,
you’d have to find a separate prescription drug plan and there’s dozens in
every county. Brian Therrien: Okay.
So, you’d still need D? John Connor: You always need D. Brian Therrien: Always need D.
So, the supplement is going to cover...is going to hedge your bet or
cover the 20% on A and B, right? John Connor: You know what, that’s
actually a pretty good way to put it, to say you’re hedging your bet.
That’s exactly what you’re doing. Brian Therrien: Yeah.
Yeah. John Connor: And then D runs independent. Brian Therrien: Spent a few days at the
horse track. John Connor: Okay. Brian Therrien: I don’t tell many people
about that, but, okay. Let’s see
here. Well, that’s good.
You know, I was really confused when I started this call, as much as I
tried not to be, but you...and I tell ya, if you can unconfused me, I know
you’re going to be able to help a lot of people.
So, this is really good. Anything
else on a...we’ve covered, this supplement that’s anything else that would
be helpful to know on that? John Connor: Yeah.
I think there’s a couple of things that...or one term that we need to
cover and explain the difference is and strategies with the one term, and
that’s underwriting. Underwriting
is someone at the insurance company who has the ability to make a decision on
your health coverage based on your condition of health.
What it means is that for some plans, if you apply and you’re not in
the state of health that they need you to be in, your rates can be higher or
you can actually be declined. Now,
this does not happen in Medicare Advantage or in part D Plans.
Those plans are guaranteed issue, which means that if you’re Medicare
eligible, you can take one of those plans and you can change it every year, so
if you find you’re in a lean plan and your needs change at the end of every
year, you want to get a richer plan to cover more situations or lower co-pays
for your prescriptions... Brian Therrien: Um-hum. John Connor: ...you have the right to do
that every year as long as you’re A and B eligible. Brian Therrien: Okay. John Connor: And that’s with your
Medicare Advantage and your prescription drug.
Medicare supplement, on the other hand, does require underwriting,
which means that you have to answer health questions and they can increase
your premium or deny you for coverage. Most
people who get a Medicare Supplement Plan keep it for life.
They don’t change every year, but there is a potential that someone
cannot get coverage under Medicare Supplement. Brian Therrien: Okay.
Here’s a question for you. Let’s
go back to...let’s go back to when we were talking about Medicare and
somebody had not worked 40 quarters and they may pay a premium for Part A,
right? John Connor: Yeah. Brian Therrien: Does or could a supplement
have any impact on that premium that they have to pay? John Connor: Unfortunately no.
That is...the Medicare A and B is really a contract with the individual
and the government. Brian Therrien: Okay. John Connor: And the Medicare Supplement
Plan, as long as that person is eligible for A and B, then a supplement plan
will cover costs, but it doesn’t have any impact on their actual eligibility
or the premium that they pay to the government. Brian Therrien: Okay.
So, it’s really isolated to just the 20% and if somebody hasn’t
worked 40 quarters, they have to pay whatever premium is assessed on them to
get the 80/20 deal, right? John Connor: Correct. Brian Therrien: Okay.
Good. Let’s talk about
what’s going on with the latest Medicare news?
There’s a lot actually, but what can you share with us and our
listeners out there that’s...that would be helpful for them to know.
I mean, that they’re getting into selling generics from what I
understand. John Connor: Sure.
Well, I think there’s two issues that we can talk about and one is
the generic drug issue and the other is private fee for service.
I’ll start with...we’ll start with the private fee for service and
this is actually very new. There
were complaints from people about these Medicare Advantage Plans and, in fact,
a lot of times we’d have people call us and say, oh, heard all about these
Medicare Advantage Plans and this and that and the other thing, and that
really stemmed around these plans called Private Fee For Service.
Those are plans that had no network, so there was no guarantee that a
doctor would take it or not. Now,
many doctors took it, many doctors didn’t, but what it meant was your doctor
had the ability, at any time during the year, to decide not to take the
insurance anymore. Meanwhile, you,
as the individual, were not allowed to change that plan.
So, if you doctor, in July, said I don’t take Private Fee For
Service, I don’t take PFFS anymore, you can’t see that doctor and you’re
locked into the plan. Brian Therrien: You’re stuck. John Connor: You’re stuck.
Well, the government came down and said, this doesn’t pass the smell
test. So, as of 2011, any Medicare
Advantage Plan has to have a negotiated network.
That means if your doctor’s in the network on January 1st,
they have to take the plan for the entire year.
So, when people do look at the Medicare Advantage world and they look
at the Medicare Advantage Plan, these Private Fee For Service Plans are going
to be gone in two years. So, it
wouldn’t be wise to get one now. Stay...we
don’t work with them really in many situations.
We have few clients in some very isolated areas that, for which Private
Fee For Service was their only option and they’re being folded into a larger
national network we’ve already found out.
So, we’re not too worried, but there are Private Fee For Service
Plans out there that will be gone in two years and it will require people to
make all new change, all new selections, and, at the same time, more doctors
every year are starting to decline accepting these Private Fee For Service
Plans. So, it’s just something
to be very concerned about. Brian Therrien: Um-hum.
So, as to be expected, the ever changing Medicare environment.
Got to be tough for people to stay up on this? John Connor: It is and that’s why we
have jobs. Brian Therrien: Yeah. John Connor: Because that’s what we do. Brian Therrien: Yeah. John Connor: You know the other thing you
mentioned was the generics and that really goes to the donut hole.
As I mentioned earlier someone like my wife who take a $1,600 monthly
prescription, there’s nothing we can do about it.
It’s an injectable drug for arthritis.
She can’t take it...there’s no alternative.
But, many people that are in that donut hole range that find themselves
going in but not coming out, these are people that use somewhere in the
neighborhood of $2,000-$4,000 in prescriptions. Brian Therrien: Um-hum. John Connor: Well, the insurance
companies and the government really want to push people from those drugs to
generics and there...it’s very difficult if you’re using all generic drugs
to see it cost over $2,000 a year. So,
it’s...normally what you’re seeing in that $2,000-$4,000 annual range of
prescription costs is someone who’s on...is someone who’s on brand name
drugs and the insurance company and the government are trying to get people
off those brand name drugs, onto generics. Brian Therrien: I smell a little bit of a,
you know, a contest going on here between the insurance companies, the
government, and the drug companies. Drug
companies... John Connor: Yeah.
Who really writes these bills? Brian Therrien: Yeah.
Yeah. John Connor: Unfortunately.
I mean that’s...it’s very confusing and, you know, the government
doesn’t want to be...doesn’t want to be promoting the use of the
high-cost, brand name drugs. Brian Therrien: Um-hum.
Um-hum. John Connor: And that’s what the donut
hole’s there for. Brian Therrien: Yep.
Well, they’re actually, you know, they’re paying for them. John Connor: Right.
Right. So, you’ll find
that there’s almost always...well, every Part D plan has to cover at least
one drug in every category and most cover...if there’s a Tier 2 or Tier 3
drug, most often, there is a potential Tier 1 substitute. Brian Therrien: Um-hum. John Connor: Now,
one thing I will say is this, I don’t know about any individual’s drug
regimen and I know there are doctors out there that say, I absolutely,
positively will not substitute a generic for XYZ brand drug.
Other doctors will, some doctors won’t, so I’m not...I would never
advocate someone mandate their doctor change their drug regimen, but it is
something worth investigating. Is
there potential for a generic rather than this Tier 2 or Tier 3 drug.
I mean we’re talking about our own pocketbooks here.
We’ve got to protect them. Other
than your health, your finances are next, and if there’s a way to save
money, it’s a good idea to ask your doctor, is this the best thing for me
physically and is this the best thing for me in my pocket? Brian Therrien: Good advice.
Great advice. Okay.
You know what I’d like to do now is I’d like to take some questions
and I want to address the folks in the conference room here for
a minute that are online. We
have some questions that were sent in, John, that I’ll go through with you,
but for the audience, I’d like to take some questions that are live.
So, in...if you’re looking at your computer screen, how you can
participate and ask a questions to John, directly, is there is a hand raising
feature on the console, the little piece of software that you’re using.
It actually looks just like a hand.
I see some of you have actually found it in the room.
Norman Chapman good job if that’s you on the list and there was
somebody else. So, Margie has a
question as well. So, if you have
questions, just raise your hand. What
I’m going to do is I’m going to go through a few questions that were sent
in prior to the call and I’ll come back to you folks in a moment and we will
certainly take your questions. Okay.
Alright. You ready for some
zingers? John Connor: Sure. Brian Therrien: Alright.
Here’s one that was sent in from Linda.
She has pre-existing conditions and she’s approved for SSDI and
she’s afraid that she will not get Medicare.
I think I know the answer to this. John Connor: Right.
Well, she will definitely qualify for Medicare.
I think where Linda may be concerned is what happens in the next two
years. Brian Therrien: Um-hum. John Connor: Because there’s this
waiting period. At that point,
there’s, if it’s a need-base situation, I think Medicaid or the state
health program is worth investigating and I’ll defer to you on some of those
other alternatives that you mentioned earlier.
Brian Therrien: Um-hum.
Um-hum. So, again, the deal
is with Medicare, if you have worked your 40 credits, then you’re going to
be eligible. There’s no
pre-existing condition clause in there. They
take everybody. That’s why they
cover our disabled population. And
if you didn’t work then, of course, then there’s a premium of some sort,
if you didn’t work the 40 credits, so, right? John Connor: Right. Brian Therrien: Right.
Good one. We have another
question here. Somebody is on
Medicare and they have special needs, like a personal assistant, that Medicare
doesn’t cover and I believe you touched on this.
In Part...is it Part A or B? John Connor: It would probably
be...you’re probably talking about Part B here and this is...is this someone
who helps with bathing, dressing, light chores, that kind of thing? Brian Therrien: Needs personal assistant.
Medicare will not cover it. Doesn’t
exist. John Connor: Right.
It sounds like a long-term care situation. Brian Therrien: Yeah. John Connor: Where there’s custodial
care being administered and, unfortunately, Medicare does not provide any kind
of relief for that unless there’s a 3-day hospital stay. Brian Therrien: Okay. John Connor: If
there’s a 3-day hospital stay, then Medicare will contribute to a good
portion of that personal assistance cost.
So, there’s potential relief there, but, and that resets every year,
but it does require the 3-day hospital stay.
You know, unfortunately, that long-term care is one thing that that is
left off on the Medicare. It is
covered under Medicaid, but, again, you’re talking about a need-based
initiative there. Brian Therrien: So, is this something that
somebody could get in Medicare Advantage?
Would that be a possible solution for something like this? John Connor: Unlikely. Brian Therrien: Okay. John Connor: There’s some relief, but,
you know, the Medicare Advantage Plans, the ancillary benefits that they tend
to offer shade more towards vision, hearing, and dental, and this is not
something I’ve found to show up a lot in the Medicare Advantage Plans, if at
all. Brian Therrien: Um-hum.
Um-hum. And we have another
similar question where somebody is not able to get Medicare to pay for the
necessary ramps for scooter and car lifts.
Now, they can get a scooter compensated for, but they can’t get out
of their house or their car. John Connor: Right. Brian Therrien: Which is an interesting
situation. John Connor: Yeah. Brian Therrien: So... John Connor: Yeah.
That is just one of those squirrely things that they haven’t figured
out how to best serve the needs of the people yet. Brian Therrien: Um-hum.
Um-hum. Okay.
What about dental insurance? Got
a couple of questions about dental insurance.
We didn’t cover it in any of the A-D that we talked about.
Don’t know if it’s available, what people can do? John Connor: Right.
There often is dental insurance available on the individual...on the
individual market. A lot of time
what you’ll find with dental insurance, if you’re not coming from a group
plan, if you’re just applying off the street, as they call it, they will
impose a waiting period. They’ll
say that you cannot get an exam with the x-rays for six months, you can’t
have cavities for six months, and you can’t have crowns, bridges, and
dentures for 12 months. Other
plans out there will not impose those waiting periods, but they may mandate
that you are in the plan for an entire year.
So, it’s one or the other. And,
then, you’re really playing a premium game of what’s the best premium
based on where I live and how can I get the best coverage, you know, but they
are available. There are dental
plans out there. Brian Therrien: Where does somebody start
their research on on a dental plan? Any
ideas? John Connor: Well, without promoting any
individual companies, a web search is always...is always a good start looking
for individual dental plans. Brian Therrien: Um-hum. John Connor: Go..call the dentist. Brian Therrien: That’s what I was
thinking. John Connor: Ask you dentist what plans
are you taking on the individual side and there are...because there are folks
all the time that have retired and lost their dental insurance and have gone
on to something else. Brian Therrien: Sure.
Sure. Okay.
Alright. I’m jumping
around here, hope you don’t mind. John Connor: No, I don’t. Brian Therrien: Let me see here.
General question. Somebody
wants to know if a Medigap Plan will be beneficial.
We can cover that one at the end. Approved
for SSDI, on Medicaid, well...just one moment.
Let me peruse this. This
one’s from Nancy. Okay.
We covered this one pretty much, too, somebody’s approved for SSDI,
they’re on Medicaid. Wants to
know if Medicaid will be in place until they are Medicare eligible?
Would there be anything apart from a shift in assets that would change
somebody’s Medicaid? John Connor: No.
It would be the shift in assets, actually. Brian Therrien: Okay. John Connor: Now, Medicaid may send
someone to do an interview every six months, to do a status check.
I know, we’re going through this right now with my grandmother, they
keep sending someone out to her nursing home to find out when she can go back
to the community... Brian Therrien: Um-hum. John Connor: ...and, um, she’s not
going back. Brian Therrien: Um-hum. John Connor: But, for two years, they
sent someone to her nursing home every six months. Brian Therrien: Wow. John Connor: So, they may send someone to
do an interview, to do a needs analysis to make sure that that the disability
is continuing, but, for the most part, no, other than an asset shift, there
shouldn’t be any major change. Brian Therrien: Okay.
Some of the questions had PACE mentioned.
Like there’s a question in here, will PACE pick up co-pays,
transportation to and from doctors and prescription drug coverage co-pays?
What is PACE? Do you know? John Connor: PACE is...it is the program
of all inclusive care for the elderly. Brian Therrien: Okay. John Connor: It works with Medicare and
Medicaid duel eligible’s. We
don’t have a lot of experience with PACE.
I know that people have to be at least 55 years old to be eligible and
they have to be duel eligible for Medicare and Medicaid and I think they’re
run...each PACE is run locally, so it’s...it’s a local decision as to
what’s covered. Brian Therrien: Like state-run program? John Connor: It might even be more local
than that. It might even be a
municipality based... Brian Therrien: Um-hum. John Connor: ...or county or depending
on, you know, some may cross state lines, but they’re really based on
centers of population. Brian Therrien: Okay.
Okay. Let’s do this,
let’s take some questions from the audience.
For those of you that are out in the audience that have raised your
hand, I’m going to give you the ability to speak and it will take a moment
for it to kick in, and I’m going to start with, let’s see here, I’m
going to start with Norman. So,
you should have the ability to speak Norman.
In a moment, you should be able to hear us, let’s see here.
Okay. Can you hear us
Norman? Alright, Norman, are you
out there? Alright, we can come
back to you in a minute. Let’s
see, who else has a question here? Shirley
has a question. Okay Shirley, can
you hear us? If you can hear us,
you’re welcome to ask your question at this time.
Let’s see if Shirley comes on. I
have another one here. You know, I
think, really, in general, if I shift down a lot of the questions and some of
the verbiage that came in, John, for people.
One of the things that everybody felt like they were exposed to is like
one guys has here, it’s...this whole thing is scandalesque.
The word, they feel like they’re being scammed and I believe a lot of
this comes from, you know, members don’t feel like they’re, you know, the
information that’s being communicated to them is forthright, and things
change and they end up stuck with a bill that they can’t pay.
So, I’m sure you’ve heard this before, but... John Connor: Sure. Brian Therrien: ...how do you...how do you
provide some confidence to people that, you know, they...they’re on the
right track or they’ve got the right plan or... John Connor: Good point.
You know, we could go on and on about about how to protect yourself.
First, understand that CMS, Center for Medicare/Medicaid Services, they
are the police. They’re the
government and they are here to look out for our best interests as
individuals. So, that’s always a
good starting and ending point. Next,
when you’re looking at an insurance company or a plan, do some research on
it. Now, some you have to research
more than others, but check out a financial rating for a company, especially
in this day and age with the economic climate as it is, make sure that the
company is going to be there throughout the year and into next year.
And find out what other people are saying about their plans.
Now, I understand that you’re never going to find a health insurance
company that everybody loves. It’s
just an industry that we all have to deal with, unfortunately, and they...some
folks are less happy about it than others.
But, do some research on the company. John Connor: Find out...make sure that
they’re reputable. The other
thing to do is ask your doctor. Ask
your pharmacist. Take some some
pro-activity and out...if you tell me to follow this course or to see this
physical therapist or if if the doctor told me to take this drug, is it going
to be covered? Is it going...am I
going to get paid back? The folks
that...oh, talk to your doctor’s billing department when you’re looking at
a medical insurance plan. Do you
take this? Do other people have
it? How is it working out?
The folks that are going to be very important are the folks that
receive the payments from the insurance company, so the doctor’s billing
office and the pharmacy. You want
to make sure that they’re okay with it, because, like you said, you might
think that you’re covered completely by something, but the folks that wind
up saying no are either the pharmacy saying, we don’t take payment for that
or the pharmacy that sends out a bill and comes back and says, XYZ insurance
company doesn’t pay for this particular prescription for this particular
durable medical equipment or for this particular service.
They’re a great asset and, you know what, it’s your right to talk
to them and ask them questions. If
they’re going to be billing you for healthcare, part of it is a little bit
of piece of mind and ask them the hard questions and make sure that whatever I
choose is going to work for me in service and for you in payment. Brian Therrien: Boy, that is great advice.
I would of never of thought to to look in those places for those types
of answers. That’s great advice.
Good. Good.
For the audience that’s out there, if you weren’t able to get
connected to to ask a question, then you can type it in the chat box.
If you pull out the console, there is a chat section.
You can just type it in there and send your question in and we’ll try
to take one more. Right now I’m
going to...see, yes, we still have some questions in the room here.
Let’s see Rose has a question. Rose,
I am going to give you the ability to speak here.
It’ll take a moment for you to become live, so as soon as you can
hear the prompt, just speak up and ask us your question. Rose:
Okay. Can you hear me? Brian Therrien: I can hear you. Rose:
Oh, okay. I just wanted to
know, I just recently received the Medicare forms telling me I’m eligible.
Now, I collect SSI disability and so does my daughter.
Is she eligible as well? John Connor: Has she gone through her 24
months? Rose:
Would her 24 months be the same as my 24 months? John Connor: Okay.
So, your daughter is a dependent on your health insurance? Rose:
Yes. John Connor: And you became Medicare
eligible? Rose:
Yes. John Connor: Is she...is she over 18? Rose:
No. She’s 15. John Connor: Okay.
Then, she would not be eligible, because Medicare won’t cover her.
There is no...there’s no disability.
What you may want to check into is is Cobra still an option for her as
an individual. Rose:
Okay. And with the
Medicare, I mean, I am eligible for that.
I would still have to get myself supplement insurance as well, because
Medicare doesn’t cover everything? John Connor: Right.
Well, you want to make sure you first get is your Part D and one of the
things I haven’t mentioned is, and this is our government at work, but you
don’t have to have Part D. However,
if you don’t sign up for it when eligible and you decide to sign up for it
later, you pay a penalty for the rest of your life. Rose:
How ridiculous is that? John Connor: So, and the penalty is
actually 1% of the average cost of someone’s Part D in the US and it’s 1%
per month if you don’t sign up. So,
basically, if you wait 10 months to sign up, you pay a 10% penalty every month
for the rest of your life. Rose:
Do I...do I have to have Medicare? John Connor: You...you do not have to
have it. You don’t have to have
Part A or Part B, but, again, if you don’t...if you decide you want it
later, you’re going to pay a penalty and you are uninsured. Rose:
Well, I’m under my husband’s insurance. John Connor: Then...then for someone
like...for someone like that, you...the first thing you want to do is contact
your husband’s employer and find out what the rules are under his employer
plan. What most employers will say
is if you are Medicare eligible, you have to take Medicare and Medicare
becomes your primary insurance and his plan will become your secondary
insurance. So, you wouldn’t need
a Medicare supplement. They would
still cover you, but they do mandate that Medicare become your primary. Rose:
Okay. John Connor: And your... Rose:
I’m sorry. Go ahead. John Connor: No.
I was going to say and your daughter would be covered under his plan
still. Rose:
Okay. John Connor: If she is. Rose:
And how about Part D? John Connor: Part D, if he is employed,
again, this is...his company’s better adapt to answer this question than I
am, but if his...if his health insurance plan offers drug coverage, than you
probably would not have to take a Part D plan.
They’ll tell you what you should and shouldn’t be doing but,
essentially, your Part D is covered by his employer plan and your Medicare
supplement, if you will, is covered as part of his ins...as part of his
employer plan, too. Rose:
Okay. Because he’s paying
additional for this, you know. John Connor: Right.
And his pre...his premium may go down if Medicare becomes your primary. Rose:
Okay. Alright.
So, I would have to contact his employer, which is going to be fun
because it’s the government. John Connor: Yeah.
You definitely want to contact them and find out what are the rules.
If it’s the government I can almost guarantee you they’re going to
tell you to take...to pay your B and...because another thing I...we didn’t
really cover, but if you are married and your spouse has put in their
10...their 40 quarters, their 10 years, then you’re covered by their Part A
and you wouldn’t have to pay the premium for Part A.
But, everybody pays their Part B. Rose::
The Part B. What is the
Part B, I’m sorry? John Connor: The premium? Rose:
What exactly is Part B? John Connor: Part B, as in boy, is your
outpatient insurance. That’s
your doctor visits, physical therapy, things like x-rays, emergency room,
those kinds of things are all covered by Part B. Rose:
Okay. Brian Therrien: As well, Rose, I will send
you the replay of this and at the top of the call... Rose:
Oh. Brian Therrien: ...we spent some time going
through that in detail. I think, I
believe you will find that helpful. Rose:
Yeah. Because I got
confused when I saw the 4:30 on the... John Connor: No. Rose:
...it said from 3:30 to 4:30 a.m. and when I looked at it I said, oh,
I’m early. John Connor: We’re here all night. Brian Therrien: Yeah.
So, just please make sure you take care of your bartender and
waitresses. Rose:
You are here all night? John Connor: No. Brian Therrien: No.
As a matter of fact, we’ve got to be respectful of John’s time.
We’re going to see if we can take one more question and and then
we’ll wrap up for the day, so. Rose:
Okay. Thank you so much. Brian Therrien: You’re welcome. John Connor: My pleasure. Brian Therrien: Okay.
That’s a good question. Alright.
Let’s see who else? Margie,
I see you have your hand up. Okay.
You should hear a prompt that allows you to say hi to us, Margie, here
coming up. Can you hear us?
Guess not. Okay.
Well, let’s do this. I
want to be mindful of your time and what I’d like to do now is just a real
kind of quick recap of what we’ve covered today and tell the folks how they
can get some help if they have any unanswered questions.
So, here’s my take and I want you to correct me if I step out of
bounds and I get...I make any mistakes in this overview here.
So, for Medicare, Part A, hospital insurance.
You’ve got to work your 40 quarters in order to be eligible and if
you haven’t, then there’s a small premium that you have to pay, right? John Connor: Correct. Brian Therrien: Part B, medical insurance.
Got to pay a monthly premium. $96.40
is what it’s at right now. If
you’ve got an income higher than that, then you might see a slight increase
in that and it helps cover doctor services and outpatient care and C, Medicare
Advantage, is basically a souped-up version of Medicare where if you
doctor’s in the network, you can have a private company like Aetna handle
your your health insurance needs. You’re
still on Medicare and this is a program that’s covered by Medicare.
Would that be an accurate overview? John Connor: So far, so good. Brian Therrien: Okay.
And D, like D for donuts, the prescription drug coverage program is
covers your prescriptions. Okay.
Alright. I think we covered
all of that. So, here’s what
I’d like to do now. At the top
of the call we talked a little bit about what Transition Assist does and
hopefully from going through the questions that you have and some of the folks
that we were able to speak to, you got an idea of some of the concerns that
people have out there. How could
Transition Assist help eliminate some of the concerns and help people choose
their best options? John Connor: Well, what we do for a lot
of folks is kind of put them through a needs analysis to find out what their
drivers are. What’s important to
them. Whether it’s I want to
make sure I can see my own doctor or I want to make sure that if I go see my
son or daughter in North Carolina for two months a year, that I’ll have a
plan that will work wherever I go. We
teach people the new rules, the new terms, the new processes that they have to
be aware of when they are entering this Medicare world and we show them out to
compare plans so that they can look at two plans side-by-side and say, okay, I
know what the differences are for folks. Brian Therrien: Um-hum.
Um-hum. John Connor: We help them with
their...with their drug plans by kind of going over their drug regimen with
them and tell them what kinds of plans are going to cover what things and
where they may see a pitfall. Often
we can...we can project where someone will fall into the donut hole, in what
month, and how that will impact their finances. Brian Therrien: Very helpful. John Connor: So, these are the kinds of
things we do. We have folks here,
we call them Benefit Specialists, and their only responsibility is to walk
people through their decision-making process, their education process, and
then help them find a plan and actually help them enroll in plans. Brian Therrien: Um-hum.
And I’m sure for the audience that’s listening out there, they’re
probably wondering well, okay, this sounds good, but how much...how much does
it cost? What makes Transition
Assist techs and, you know, would somebody be able to afford speaking with... John Connor: Sure.
And that’s...you know, I guess the best answer to that is the honest
answer and that is, as a corporation, as a company, we get paid by the
insurance companies that we represent. So,
we get paid by them, not by the individuals we speak to.
However, we’ve drawn a line that doesn’t get crossed over.
And that is, the folks that talk on the phone to our people do not get
paid commission, so what they’re going to do is look out for the best
interest of the individual. They
have no idea what the insurance companies pay us, they get paid a salary, and
actually they get their incentives and their bonuses based on how well they do
with our clients. Happy clients,
educated clients are what we’re looking for.
We want to make sure that we’re doing the right thing by them.
So, the folks that they talk to do not get paid commission.
They’re interests are aligned with these people to make sure that the
right plan is found. Brian Therrien: Um-hum.
Very nice. Very nice. John Connor: So, it doesn’t cost the
retiree or the...doesn’t cost the individual anything. Brian Therrien: Okay.
Alright. Yeah, I mean,
people, of course, when your income...when you become...when you retire where
you go out on disability or...it’s a cost-conscious world, especially in
today’s economy. So, really what
they’re able to do is kind of zero in and see if they might be able to save
some money on an existing plan, if you’re properly covered, help somebody
understand what all their options are? John Connor: Right. Brian Therrien: Okay.
Very good. Very good.
Anything else you can think of that would be good to know? John Connor: No.
We’ve...I’m looking over my notes to make sure that we hit on just
about everything. Brian Therrien: Um-hum.
Okay. And I know that you
were kind enough to allow folks from the Disability Digest to contact your
group and assign a specific person for them to speak to, so for those of you
who are listening on the call today and want to know how to take advantage of
really a free benefits review or consultation about your benefits so you can
understand if you’re, you know, what your options are, if you’re properly
insured, you can take a look at the screen.
There’s a phone number up there you can call and there’s directions
right below, the times, etc. You
can do that if you’re listening to the replay, you’re directions will be
slightly different, so just scroll down to the bottom of this page and you
will also be able to take advantage of this offer as well.
So, good. Well, listen, you
know, again, this has been a very confusing topic for me and it’s like a
breath of fresh air. You’ve
really sorted out a lot of things, John, and, again, if you did it for me,
I’m sure it’s going to help a lot of people.
So, I thank you for taking the time today and helping us...helping us
sort this out, so. John Connor: My pleasure. Brian Therrien: Yeah.
Good. For the audience, the
resources that we mentioned will be circulated around in the replay of this.
We have a conference every month. It’s
typically the first Wednesday every month, so mark your calendars, look at
your inboxes. If there is
something that you’re looking for that’s disability related that was not
covered in the call, whether it’s housing or maximizing your benefits or,
you know, any of the other services, I encourage you to go into the members
area and have a look there, which you can find by going to the
disabilitydigest.com and in the top right-hand-corner you’ll see the members
areas where all the services are that have been provided.
So, so, again, John, as we wrap up today, thank you, thank you, thank
you very much for taking the time out of your day and spending it with us.
Certainly appreciate it. John Connor: It’s been great. Brian Therrien: As well, the audience, thank
you for taking the time. Until the
next conference. Appreciate your
attendance. So that Transition Assist can best address your health insurance needs, both today and in the future and send you updates please take a moment to complete all the questions below. My goal is to restore your peace of mind that you're properly insured and isn't adequate health care something we all deserve?
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