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Seniors Living Healthy

Seniors Living Healthy

Author: Senior Benefits, Inc.

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Join your hosts Nick Keene and Zach Haire fireside as they discuss the things you need to know as you or your parents begin to live out your golden years. With over 50 combined years in the senior market across the country, Nick and Zach are experts in the senior market and are here to help you live a healthy, full life.

This show's focus is on providing information on Medicare and products that most people won’t take time to explain. They dive into the hard questions and explain things in an easy to understand way. They also have guests on that work in different areas of health and wellness that will be able to give insight and address ways for you to stay healthy.
10 Episodes
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Nick and Zach are back to give us some more essential information about the more commonly purchased products for Medicare beneficiaries. They break down everything that you’ll need to know by category and product. As a result, they have a very handy guide to what you’ll need.They discuss products in dental, vision, and hearing, and what is available there. Importantly, they discuss cancer coverage and what’s applicable there. They also break down life insurance opportunities and address any potential questions that arise there. Check out their conversation for the full scoop!Show Notes Dental Vision and Hearing 00:26 Cancer Coverage 06:26 Life Insurance 13:36 Links Referenced: nick@getsbi.com zach@getsbi.com
For this episode of Seniors Living Healthy, Zach and Nick break down medicare supplements and coverage. They distinguish some of the differences between the plans, and what you can expect with the type of care they provide.Zach and Nick kick things off by discussing medicare supplements. As the name indicates, they supplement your medicare as a secondary policy to your primary. Zach and Nick shine some much-needed light on the subject. They also cover the gap from the last episode and discuss Medicare Advantage i.e. “Part C.” They break down how it works, and what you need to know. They close with the Pros and Cons of each topic so that you can make the best decision to fit your needs.Show Notes 00:00 Introduction  00:23 Medicare Supplements 14:29 Medicare advantage (Part C) 29:57 Pros and Cons Links Referenced zach@getsbi.com nick@getsbi.com
Show Notes 00:00 Introduction 00:22 Medicare part A 06:39 Medicare part B 15:35 Medicare part D Links Referenced: medicare.gov: https://medicare.gov Zach’s email: mailto:zach@getsbi.com Nick’s email: mailto:nick@getsbi.com Facebook: https://www.facebook.com/seniorbenefitinc Webpage: https://seniors-livinghealthy.com/ TranscriptAnnouncer: Welcome to our fireside chat with Seniors Living Healthy, the podcast that helps prepare and educate you as you enter and live out your golden years. With over 10 years of experience, Nick and Zach are experts in the senior market and are here to help you live a healthy, full life. And now fireside with your hosts, Nick Keene, and Zach Haire.Nick: Hello, and welcome to season two of Seniors Living Healthy, episode one. I’m Nick. And I have Zach, our co-host with us.Zach: Hey, folks.Nick: And for episode one of season two, we want to cover parts A, B, and D of Medicare, and the changes for 2022. So Zach, let’s jump right in.Zach: Sounds good. So, kind of start off there from the top, Part A, just like in the alphabet, starting out with the first letter there, you know, that is our hospitalization, sir. You know, Nick, what are some common things that Part A covers?Nick: Yeah, so Part A kicks in when individuals are admitted to the hospital. It’s worth mentioning, Zach, that they’re admitted because we are seeing more commonly that people are being put in the hospital under observation. And that is actually covered under Part B. So, very simply, anytime someone is admitted to the hospital, not under observation, Part A kicks in.Zach: Got you. So, let’s say, you know, I’m getting ready to turn 65 in a few months. I’m still working things like that, how do I get Part A? What do I have to do to qualify for it?Nick: Great question, Zach. We do get this question quite frequently. So, the most common way to qualify for Medicare is those individuals that have worked 40 quarters or ten years and paid into Medicare via payroll taxes, right? Those individuals get Medicare the month of their 65th birthday.Zach: Got you. So, no matter what, they’re going to get Part A. I know you said you paid into it while you’re working. Is there any additional costs added to that?Nick: Right. So, great question there, Zach, and worth mentioning here as well. For those individuals that qualify traditionally for Medicare, they worked 40 quarters, ten years, and paid in, Part A is premium-free, think of it as prepaid. But also you have those individuals that may qualify based on their spouse’s, right? Their spouses may have worked 40 quarters or ten years, they also qualify for Medicare Part A the month of their 65th birthday.Then the third situation, there is a cost. And those individuals that don’t have a spouse that qualifies for Medicare they can draw off of and don’t have the credits themselves, depending on how much they have worked and paid in, Part A can be purchased.Zach: Yeah. So, you do still have the ability to get Part A, if you don’t ‘qualify’, you can always pay for that and pick it up.Nick: Absolutely.Zach: So, we know that in most cases, there’s no additional premium; you’ve paid into it as you were working. Are there any other, you know, common costs associated with using Part A, whether it be a deductible, whether it be you know, skilled facility care, things such as that?Nick: Absolutely. So, yeah. So, basically with Part A, the way it works is it’s designed with what we call a Medicare period of care, right? So, when those individuals that have Part A are admitted to the hospital, they are immediately responsible for a $1,556 deductible in the year 2022 that covers their first 60 days in their period of care, right? So, for those individuals, they go in, they pay that $1556 deductible, they’re covered for the first 60 days, right?But it’s worth mentioning that if they go beyond day 60 they do have additional cost, right? And that period of care doesn’t end until they go a continuous 60 days without accessing care under Part A. So, assuming their period of care extends, day 61 through 90, those individuals are going to be responsible for $389 a day that they’re in the hospital, and day 91 and beyond using those 60 lifetime reserve days, they’re going to be responsible for $778 a day. You know, and the other thing to touch on here, Zach, that you mentioned is skilled facility care, right? So, we’ve seen a major transition in our market over the last five to ten years.You can recall when we were little, people had extended stays in the hospital, you know, people were in their one, two, four, six months. That doesn’t happen really anymore, right? What we’re seeing, the trend is individuals are being admitted to the hospital, they’re being stabilized, and they’re being shipped off to skilled facility care centers, right? And you know, whether that’s for a hip replacement or a knee replacement, they fell and they broke something, speech, occupational therapy, whatever it may be, these individuals are staying at the skilled facility care centers for extended periods of time, not in the hospital. So, to qualify for Medicare to cover skilled facility care, they have to be in the hospital for at least three days and be admitted to the skilled facility care center within 30 days of being discharged. If those criteria are met, Medicare will cover day 1 through 20, one hundred percent, and then day 21 through 100, the individual is responsible for $194.50 per day.Zach: Got you there. So, you know, once someone is on Part A [everything 00:05:16], is there any limits where they can go, networks, anything like that?Nick: Yeah, one of the beauties of Medicare, Zach, and you know, we tell clients this all the time is Medicare’s a nationwide program, right? California, North Carolina, Michigan, to Florida, and everywhere in between. They can access care, right? And that’s one of the great things about Medicare is almost all facilities, almost all doctor’s office accept Medicare. So, they have no restrictions, they can go just about anywhere they want.Zach: Got you. So, kind of wrapping up Part A there is, anyone can get that as long as you’ve worked 40 quarters or your spouse has worked 40 quarters. You’re able to get that the month you turn 65, the first day of the month.Nick: Absolutely.Zach: And no matter whether you’re continuing working or what you’ve got Part A?Nick: Yep.Zach: And with Part A alone, there was a $1,556 deductible on that they’d be responsible for but then, you know, it does help you in the skilled facility care things such as that, along with your 60-day continuous window of care. And again, no network so you can go wherever you want to go if you’ve got that Part A; pretty much every hospital, I’d say, in America takes Medicare.Nick: Absolutely, Zach. And just to wrap up on Part A, you know, one of the things that people need to remember is Part A is just hospital admittance insurance. Most of your typical services that are everyday needs are happening on outpatient care, or Part B, which we will be covering shortly.Zach: All right, so now we’re going to roll into Part B, again, following our alphabet here, B comes right after A. So B, if you look at your red, white, and blue Medicare card, it is going to say medical, but we refer to it as outpatient.Nick: Absolutely, yeah. Yeah. And, you know, we try to eliminate confusion there because the Medicare card says ‘hospital’ for Part A and ‘medical’ for Part B, but we kind of feel both of those are medical, right? So, we like to explain Part B as anything that is outpatient care, or care that is not admitted into the hospital.Zach: Exactly, yeah. So, kind of got that cleared up. What exactly does it cover when it comes to different things?Nick: Yeah. So, Part B is by far the most common Medicare part, right? It’s the most common used, and it literally covers any Medicare-approved charge outside of being admitted to the hospital, right? So, that could be hospital admittance under observation, that could be lab work, physical therapy, CAT scans, MRIs, doctor visits, primary care, or specialists, durable medical equipment, diabetic testing supplies, all those things encompass Part B.Zach: So, we know in Part A you get that automatically when you turn 65. Part B work the same way, or is there a few more hoops to jump through for that?Nick: Yes. So, for Part B, you know, that individual that qualifies for Medicare, either off their work experience or off of a spouse’s work experience, they still are eligible to get Part B the month of their 65th birthday, right? However, with Part B, there is a premium, so Medicare does allow it to be elective.Zach: So, with it being elective, how does that situation play out? Do I have to take Part B when I turned 65? If I have creditable coverage, am I fine? You know, if I don’t take am I going to get penalized? How does that work?Nick: Yeah, so we’re seeing this question come across our desk more and more, Zach. It seems like in this day and age, more and more people are working post-65. We didn’t run into this a lot five years ago. But basically, the way it’s working is for those individuals that are Medicare-eligible, turning 65, they qualify for Medicare, they can still take Part B the month of their 65th birthday, but if they’re still working and have credible coverage, right, which is defined as coverage, at least equivalent to Medicare, they do not have to take Part B. They can postpone it without penalty, assuming they have credible coverage.Zach: Got you. So, you said, you know, 2022, that average premium is $170.10.Nick: Yep.Zach: Which leads you to say if that’s the average, there can be some outliers. Is there a way to make that cost lower?Nick: Yeah. So, you know, for a lot of individuals out there, they qualify for what’s called Medicare Savings Programs, right? And we know those different programs, whether that’s QMB, SLMB, Extra Help those types of things, those programs are designed to
Some of the highlights of the show include: A brief rundown of Medicare Part A, who is covered under the plan, and where their coverage might run out The differences between Medicare Part A and Medicare Part B, and which one has a premium IRMAA and how it can allow people to pay less or more for their premium depending on their income How Medicare Part B costs break down Which part of Medicare pays for the shingles shot What Nick and Zach think listeners should know about the Medicare Part D’s “doughnut hole” How Medicare Advantage plans can help fill Medicare gaps Why you can’t really have a Medicare Advantage plan and a supplement plan Why it’s never too early to start saving for retirement And more! Quotes“Part A is paid in typically via payroll contributions, 10 years or 40 quarters, and there is no premium. With Part B there is a standard premium and in the year 2021, that premium is $148.50 per month.” — Nick“Part B is elective. So, whereas Part A is automatic, there are plenty of individuals that are still working when they turn 65. They may have insurance through their retirement, through their union; that's considered credible coverage, so it's certainly elective.” — Nick“The important thing to remember folks is prescription drug plans all have to meet a minimum benefit that Medicare determines, okay? And what that means is they have to cover at least two drugs in every therapeutic class. However, some drug plans may cover different drugs in those therapeutic classes. So it's important that you reach out to a professional.” — Nick“A lot of times with an Advantage Plan, you're looking at paying less than the front end where you might possibly with copays and deductibles on the back end see a bill.” — Zach“I recently turned 60. So, a lot of what I'll talk to you about is really based on my own experiences. I'm going through this in real-time.” — Ty Wooldridge“My background was in actuarial science, and I can tell you that the time value of money is an important ally when you're retiring. If you just took $50 a week, and you invest in that, even at a really low rate, like 4% which, as an average rate for 40 years, which is fairly low, you have a quarter-million dollars by the time you're 40 years out.” — Ty WooldridgeTranscriptAnnouncer: Welcome to our fireside chat with Seniors Living Healthy, the podcast that helps prepare and educate you as you enter and live out your golden years. With over 10 years of experience, Nick and Zach are experts in the senior market and are here to help you live a healthy, full life. And now fireside with your hosts, Nick Keene, and Zach Haire.Zach: Hello, and welcome back to episode six of season one of Seniors Living Healthy. I'm joined here as always with Nick.Nick: Hello, folks.Zach: So, this episode, we're going to wrap up what we've covered the first five episodes this season, touch base over what we have talked about, do a little refresher, review course. And then we're going to look into what next season is going to bring, and that's where our guest, Ty Wooldridge, President of Aetna Senior Supplements, will come in. We interview him, kind of looking forward to financial security once you do retire. So, as we just jump in here, we're going to talk about the parts of Medicare and the different things out there that can fill in those gaps in Medicare. Nick's going to run through those for us. I'll ask him some questions, he'll just review them real quick to make sure everybody's up to speed if you're just now joining us, you’ll know we've touched on the last five episodes. So, Nick, as you know, we've been discussing the parts of Medicare this past season. Nick: Sure. Zach: So, real quick, let's start out with Part A of Medicare, give the listeners a run-through on that.Nick: Yeah, so I want to start out real quick with the Part A and Part B, Zach, about who qualifies, when they qualify, and when they get it. So, individuals that have worked 40 quarters or 10 years and paid into Medicare, [unintelligible 00:01:45] payroll taxes mainly, qualify for Medicare, including any dependents and or spouses of those individuals. And other individuals, whether it be through disability, in limited circumstances regardless of age, or end-stage renal disease, or ALS can qualify as well, Zach. So, back to Part A, your question. Part A is hospitalization. Anytime an individual is admitted to the hospital, they are covered under Part A and a couple things to remember under Part A is there is a period of care: that is 60 days, and that is covered with a $14058 deductible in the year 2021. So, beyond that, there are additional day costs, day 61 through 90 in the period of care $371, and then 91 through 150, they're responsible for approximately $742 per day. The other thing that we're seeing more in this market as it regards to Part A, Zach, is skilled facility care. I know you and I talk with clients about this quite frequently. But skilled facility care comes in a lot when people have to go to rehabilitation facilities, whether it's following a stroke or some sort of debilitative condition. And if they are in the hospital for three or more days, and released, and admitted to a skilled facility within 30 days, Medicare will pay day 1 through 20, and then they're responsible for day 21 through 100 at approximately $185 per day. And that pretty much rounds out Part A, Zach.Zach: Great. So, real quick on Part A, circling back there talking about the days in the hospital, the window of care, we know it's a 60-day window of care. Kind of, explain how that resets, how that works.Nick: So, a period of care ends when an individual goes 60 days without care in the hospital or surrounding arena. So, not to be confused with the first 60 days period of care that's covered under the Part A deductible, but also beyond that going 60 days without additional care.Zach: Great, perfect. So, rolling in there. Next part is our Part B of Medicare, which is a lot more in play than Part A does.Nick: Absolutely. So, Part A is paid in typically via payroll contributions, 10 years or 40 quarters, and there is no premium. With Part B there is a standard premium and in the year 2021, that premium is $148.50 per month. There is something called IRMAA, Zach, that can allow people to either pay less for their premium or more, depending on their income. Your Part B is elective. So, whereas Part A is automatic, there are plenty of individuals that are still working when they turn 65. They may have insurance through their retirement, through their union; that's considered credible coverage, so it's certainly elective. Reach out to us, reach out to someone to answer your questions about what may work or what may not work in that regard. But if someone does elect to take Part B, they can expect to pay a premium typically. And Medicare Part B has an 80/20 coinsurance: Medicare pays 80% of all outpatient claims, and the insured is responsible for the remaining 20% after a $203 outpatient deductible.Zach: So, a little trivia question for you, Nick. We get asked this all the time: Part A or Part B; which one pays for the shingles shot?Nick: Shingles. That's a good question. Shingles is covered under the Part D. Your flu shot is the common shot covered under Part B.Zach: All right. There you go. So, leading into that, like Nick just said, your Part D of Medicare. That's probably our number one complaint—Nick: [laugh]. Yeah. Absolutely.Zach: —that we get because our hands are pretty tied on that. Kind of want to touch base on those there, Nick? Nick: Yeah, so one of the biggest challenges that we run into Part D, Zach, is they're regulated. You can only make changes, typically October 15th through December 7th outside of your open enrollment or new to Medicare phase. And with effective dates taking effect 1/1. And outside of limited instances, people are locked into those plans, January 1st through December 31st. And people's medications have a way of changing. A lot of times we get individuals that we run a drug plan, it seems like a perfect fit. Things arise, health conditions arise, new medications come into the picture, and we get phone calls, “Oh, this medication costs $100 a month,” or whatever that is, the important thing to remember folks is prescription drug plans all have to meet a minimum benefit that Medicare determines, okay? And what that means is they have to cover at least two drugs in every therapeutic class. However, some drug plans may cover different drugs in those therapeutic classes. So it's important that you reach out to a professional, reach out to us, let us look into the options. Let us get a list of your scripts, your dosages, the frequencies you're taking them, let us make sure that we get you with a preferred pharmacy that's going to offer you the lowest cost for your drugs. All of those things are important when it comes to picking a drug plan. And keep in mind, Zach, just to circle back, with Part D and Part B, if a Medicare-eligible enrollee doesn't have credible outpatient or Part B coverage or Part D drug coverage, they can be penalized by Medicare.Zach: Yeah, they'll get their part, cut one way or the other, that's for sure. So, one more thing I want to touch on Part D of Medicare, we get questions all the time, the dreaded doughnut hole. Do you want to touch on that real quick?Nick: Just to build up to the doughnut hole real quick, Zach. There's four phases in a drug plan: the deductible, the initial phase, the doughnut hole, and the catastrophic phase. And one of the things to keep in mind is, it's dollar amount thresholds that move from one portion or phase of the drug plan into another. So, when an individual and the insurance company reach a combined out of pocket total of approximately $4100, they enter into the doughnut hole, in 2021. And once they enter into that doughnut hole, then it's an approximate combined total of $10,000 that has to be spent between the insured, the insurance
Some of the highlights of the show include:  A brief primer on the history of Medicare Supplements Why Danny believes that Medicare Supplements are a great option for people How Medicare Supplements plans can’t be canceled based on a year of high claims The difference between when you can buy Medicare Advantage plans and when you can buy Medicare Supplements plans What happens if your doctor drops out of the Medicare Advantage plan you’re enrolled in The more popular Medicare Supplements plans that Zach and Nick see most commonly Changes to the Medicare Supplements program that just went into effect on Jan. 1, 2020 How Nick was able to help a couple save upwards of $2,400 on Medicare Supplements plans How Nick and Zach’s persistency can be a boon for clients And more! Quotes“President Johnson is the one that signed Medicare into law, and that was done in 1965. And soon after that, a multitude of companies brought out Medicare type Supplement Plans. they were going to cover what Medicare didn’t, but they could add bells and whistles and different things that way.” — Danny “That's what makes Medicare Supplements a great deal for people because it leaves them in control of what they want to do as far as their healthcare is concerned.” — Danny“Medicare Supplemental policies are secondary to Medicare, meaning Medicare is still their primary, meaning it's a nationwide program, they can go anywhere that accepts Medicare. And they're also standardized. So, the coverage from one company to another is identical from plan to plan.” — Nick “You can only buy Advantage plans at certain times of the year with the annual enrollment period, whereas you can buy a Supplement any time of the year.” — Zach“If you're in a Medicare Advantage Plan and your doctor drops out of it, there's nothing you can do until the open enrollment period.” — Danny “Medicare has evolved, coverages have been added, things have changed, and the same is true with the Part D. It's been evolving where it gets better and better as time goes on.” — Danny“Since the plans are standardized, we had the capability to find the same benefit package, the same coverage with another provider saving them a ton of money.” — NickLinks Seniors Living Healthy: seniors-livinghealthy.com Facebook: facebook.com/seniorbenefitinc Contact Nick and Zach: zach@getsbi.com 1-844-437-4253 TranscriptAnnouncer: Welcome to our fireside chat with Seniors Living Healthy, the podcast that helps prepare and educate you as you enter and live out your golden years. With over 10 years of experience, Nick and Zach are experts in the senior market and are here to help you live a healthy, full life. And now fireside with your hosts, Nick Keene, and Zach Haire.Zach: Welcome back to episode five of season one of Seniors Living Healthy. I'm your host, Zach, and with me as always, is Nick.Nick: Hello, folks.Zach: Also, we're pleased to be joined this week by Danny Haire, owner of Financial Services, Inc.Danny: Hi. How are y'all today?Nick: Doing well, sir. Thanks for joining.Zach: Thanks for jumping on here with us, Danny. So, he has been in the business for over 40 years, and can even remember back when Medicare Supplement Plans first came out. Danny, real quick, do you kind of want to just give us a quick historical rundown of Medicare Supplements, where they came from, who brought them out, that type of thing.Danny: Well, of course, President Johnson is the one that signed Medicare into law, and that was done in 1965. And soon after that, a multitude of companies brought out Medicare type Supplement Plans. The difference from those plans compared to today is there were no government standardized plans. Companies pretty much got to put together whatever they wanted to do. I mean, of course, they were going to cover what Medicare didn’t, but they could add bells and whistles and different things that way. And then as time went on, of course, the government standardized these plans. So, that was pretty much, I think, in the ’80s, when that happened, that these plans become standardized and everybody was selling the same thing, and there could not be any deviation from those.Zach: Gotcha. So, as we did discuss last episode, Medicare's got those gaps in it, and so there are plans out there to fill those gaps. As we talked about last episode, those Medicare Advantage Plans. So, this episode we're going to look at Medicare Supplements, and also, kind of similar to our last episode, instead of doing a product review, being this whole episode on a product, we're just going to kind of lump our interview portion in with our product review, just because it's going to flow so well together.Nick: So, Danny, quick question for you tell us why Medicare Supplement Plans benefit our clients?Danny: Zachary said earlier I've been in the business for well over 40 years. So, having seen changes and seeing what these plans can do for people in filling in the gaps, I just think it gives—anything that gives you control of your healthcare, in my thinking, is the best for you. You can go to any doctor, any time, any place. You're not in networks, you're not having to get pre-approvals or referrals. So, to me, that's what makes Medicare Supplements a great deal for people because it leaves them in control of what they want to do as far as their healthcare is concerned.Nick: Sure. Couldn't agree more. A couple things to point out also, Zach, that come to mind is Medicare Supplemental policies are secondary to Medicare, meaning Medicare is still their primary, meaning it's a nationwide program, they can go anywhere that accepts Medicare. And as you mentioned earlier, Danny, they're also standardized. So, the coverage from one company to another is identical from plan to plan. And more importantly, we get asked quite frequently, can these plans be canceled based on a year of high claims, or claims level? And the answer is simply no. The only way a person's Medicare Supplement Plan can be canceled is due to non-payment; it's what's called guaranteed renewability. Zach?Zach: Kind of going back, touching on a few of those points, you know, going through Medicare Supplements, as we talked about in the last episode—Advantage plans as well—you can only buy those certain times of the year with the annual enrollment period, whereas a Supplement, you can buy those any time of the year. As long as you can enter the health questions and qualify there. So, kind of on that note there, Danny, what are some pros to that capability to be able to purchase a MedSup and not—as you said, gives you the freedom. If you want to go a little more into that?Danny: Well, the freedom, to me, is the most important thing. Being of Medicare age myself, and having the flexibility if I want to change a plan, go from one plan to another, or go from one company to another, again, that's just part of the freedom and having that control that I've talked about, whereas, as you said, with the Medicare Advantage, there's certain times of year, there's certain special enrollments, maybe, that could happen. But if you're in a Medicare Advantage Plan and your doctor drops out of it, there's nothing you can do until the open enrollment period. As long as a doctor accepts Medicare, he's not going to drop out of Medicare, he's going—and so your Medicare Supplement will always cover it because, as Nick said earlier, it's a supplement to Medicare. Medicare covers the charge, and the doctor is participating in Medicare, then your plan’s going to pay.Zach: Definitely. Also too, as we've talked about in episode three and four—episode three being on prescription plans and four being on the MAPDs that include some prescription coverage—Supplements, what are they going to do for you, drug plan-wise, you know, coverage-wise, how would that work for somebody out there looking for prescription coverage along with their Supplement?Danny: Well, of course, President Bush was one that signed in the bill that included the Part D of Medicare prescription drug plans. Up until that time, the majority of people did not have drug coverage if they were on Medicare. There was, once upon a time, what was called a Plan J Medicare Supplement that did provide some prescription drug coverage in that plan. But the Part D is what really does the prescription drug coverage. It's like everything else; Medicare has evolved, coverages have been added, things have changed, and the same is true with the Part D. It's been evolving where it gets better and better as time goes on.Zach: Gotcha. And so, as we've talked about, as well, kind of going back a little bit to the plans being standardized, and as you just mentioned, a plan there, you know, there are several different plans out there in the market. There are some that are, of course, more popular than others. So, if we kind of want to run through those a little bit—maybe just hit on the more popular plans; we don't want to be here all day—going through plans.Nick: Yeah, Zach, that's a great question. So, there's a number of Supplement Plans currently on the market. But predominantly, we run into the same few over and over again, right? So, we have Plan F, Plan G, and Plan N. One thing to mention, Zach, recent legislation just passed, the MACRA legislation, limiting individual’s availability to buy a plan that covered the Part B deductible of Medicare. So, there's been a lot of news lately coming out about Plan C and Plan F, and there's a little bit of confusion around it, I think would be worth mentioning real quick. So, individuals that are newly eligible to Medicare, January 1st, 2020, or after, no longer have the ability to buy those two plans. However, individuals that were Medicare eligible prior to January 1st, 2020, can keep their current plan and purchase another Plan F or C for the rest of their life. So, that's worth noting. The other two plans mentioned, G and N are very similar to Plan F. Plan G has a deductible that an individual has to
Some of the highlights of the show include:  A brief refresher on Medicare Part A and Medicare Part B and the associated gaps in coverage The various types of Medicare Advantage plans, including HMOs, PPOs, and SNPs, and the differences between each of them Why it’s important to consider in-network coverage when shopping for Medicare Advantage plans The coverage benefits of Medicare Advantage Prescription Drug plans (MAPDs)  Three big things that Medicare doesn’t cover What Medicare Advantage covers that Medicare plans do not Why Medicare Advantage may be more convenient than other Medicare coverage options When the Annual Enrollment Period is Factors to consider when shopping for an MAPD Why you should review your options every Annual Enrollment Period no matter what And more! Quotes“There are two options, really, when it comes out there to filling in gaps in your Medicare: Medicare Supplements andMedicare Advantage Plans.” — Zach“The HMO plans are primary care physician-based. Their networks are typically county-based or sometimes multi-county based, but they're for individuals that don't do a lot of traveling. They do have set copays on a lot of services, and they typically are relatively inexpensive.” — Nick“And then the PPOs: there is no requirement for a referral on a PPO. They typically are going to have larger networks, regional, or in some cases, national networks.” — Nick“The only thing that a Medicare Advantage Plan has to do is offer benefits equivalent to original Parts A and B of Medicare.” — Nick“It's important to note that Medicare Advantage Plans wrap up and replace Part A and B, but also incorporate Part D of Medicare in the same type of plan. So, unlike Medicare, and a supplement and a stand-alone drug plan, it's all in one card.” — Nick“Medicare Advantage Plans give you additional benefits that original Medicare does not cover. It basically Medicare Advantage Plan will pick up, like, deductibles, and coinsurance, things of that nature traditional Medicare does not cover.” — Tausha“Medicare Advantage over traditional Medicare has a stopgap in place that caps the amount of spending that you would do each year, which is called a max out of pocket.” — TaushaLinks Aetna: https://www.aetna.com/ Seniors Living Healthy: seniors-livinghealthy.com Facebook: facebook.com/seniorbenefitinc Contact Zach: zach@getsbi.com 1-844-437-4253 TranscriptAnnouncer: Welcome to our fireside chat with Seniors Living Healthy, the podcast that helps prepare and educate you as you enter and live out your golden years. With over 10 years of experience, Nick and Zach are experts in the senior market and are here to help you live a healthy, full life. And now fireside with your hosts, Nick Keene, and Zach Haire.Zach: Hello, and welcome back to another episode of Seniors Living Healthy. As always, I'm your host, Zach, and beside me is Nick.Nick: Hello, folks.Zach: You guys, this episode we're going to look into the different options to fill in those gaps that Medicare covers where we've talked about in the previous episodes, with Part A being your hospitalization, and Part B being your outpatient. There are two different options out there. One of them is Medicare Supplements, which we're going to touch on next episode, where this episode we're going to focus on Medicare Advantage. You may see him also called MAPD or Part C of Medicare. Especially with Annual Enrollment Period coming up, you're going to see a lot of TV advertisements, radio advertisements, billboards, things in your mail, all of that stuff, in regards to that.So, guys, as always, usually do a product review in our episodes, but since this whole episode is on a product, we're just going to jump right into it and just cover the whole product as a whole. And then, as always, we'll go into our interview, our confession section, and then wrap up the episode. So, now that we've talked about A and B has all these gaps, this episode—and we're going to spill over into next episode—we're going to talk about what covers those gaps that Medicare doesn’t. Some different options, everything out there for you. So, Nick, give me a quick rundown just to refresh everybody, what some of those gaps are?Nick: Sure, absolutely, Zach. So, the main two parts of Medicare Part A and Part B. As you alluded to, Part A is the hospitalization, Part B is the outpatient. So, some of the major gaps under Part A of Medicare are, Medicare Part A has a $1408 deductible per 60-day benefit period. And then also beyond that, for individuals that required skilled facility care beyond hospital stays, Medicare covers all but $176 day 21 through 100, with Medicare paying 100 percent, day 1 through 20 provided that an individual is in the hospital three days or more and admitted to that facility within 30 days. Then as far as Part B, Zach, as you know, Part B of Medicare has an 80/20 coinsurance. The clients are responsible for the remaining 20 percent that Medicare does not pay, as well as a annual deductible of $198 per year.Zach: Great, Nick. So, now we're caught up with the different gaps and everything out there. There are two options, really, when it comes out there to filling in gaps in your Medicare. One of them is Medicare Supplements; we're going to spend next episode talking about this one. So, this episode, we're going to talk about Medicare Advantage Plans. You may see that also referred to as Part C, or MAPD. That's a couple of different lingo we use in our industry. You'll see it, especially with Annual Enrollment Period coming up. So, you're going to see a lot of advertisements, billboards, radio ads, things like that for those products. And so, Medicare Advantage Plan, lack of better terms, it replaces A and B of Medicare.Nick: Absolutely. Yep.Zach: So, Nick, looking out there, there are several different types of MAPDs, you want to run through those real quick, maybe touch on the two main ones that are out there, and we'll go from there.Nick: Sure, absolutely. So, there's a number of different types of Medicare Advantage Plans that are offered on the market, Zach, but the few that are the most common are going to be the HMO, which stands for Health Maintenance Organization, the PPO, which is a Preferred Provider Organization, and then SNP plans: Special Needs Plans. Those plans are specified for specific portions of the population, whether that be dual-eligible Medicare beneficiaries, institutionalized Medicare beneficiaries or Medicare beneficiaries with chronic conditions. But back to the main two, the HMO plans are primary care physician based. What that means, Zach, is the beneficiary's care is all handled directly through their primary care physician, and any doctors or specialists within that network or outside, are only available to the client with a referral from that primary care physician. And their networks are typically county-based or sometimes multi-county based, but they're for individuals that don't do a lot of traveling. They do have set copays on a lot of services, and they typically are relatively inexpensive. And then the PPOs: there is no requirement for a referral on a PPO. They typically are going to have larger networks, regional, or in some cases, national networks. So, those are some options that individuals that may travel may be more appealing. And typically, they're also pretty relatively inexpensive as well.Zach: Great, Nick, so like I said, the plans themselves are fairly inexpensive, meaning a lot of them don't have premiums, or they have very small premiums. So, they do, kind of, replace Medicare a little bit. What are some of the gaps still? Are there expenses out, that you are still responsible for on an HMO or a PPO plan?Nick: Right. So, traditionally—and unlike Medicare Supplement plans that we've talked about on our podcast, or we will be talking about shortly—these types of plans, Zach, aren't standardized. So, the only thing that a Medicare Advantage Plan has to do is offer benefits equivalent to original Parts A and B of Medicare. So, in most plans, you are going to have, day one through five, day one through eight, you're going to have per day costs while you're in the hospital, individuals are going to have copays in a lot of instances, whether it's at the primary care, or the specialist doctor visits, copays at the emergency room, copays in some instances on lab work, CAT scans, MRIs, things of that nature. And keep in mind, folks, since these plans are network-based, in some plans more than others—HMOs for instance—if you go outside of the network, short of emergency care, and other limited instances, these plans don't cover. So, it's very important if you're on one of these types of plans, or are considering taking one of these types of plans, that you consider that when you are looking to purchase one.Zach: Great, great. So, what are some added benefits that these Advantage plans have? We talked last episode about prescription plans, and you do have MAPDs out there that—Medicare Advantage Prescription Drug Plan, as in the name itself, it does include your prescription coverage. So, one—a two-part question there touched on, the prescription component of an MAPD as well as any added benefits, whether gym memberships, things such as that, that a member client could get when enrolling in one of these plans.Nick: Sure. So, the added benefits are something that we get asked about this constantly. The first three that come to my mind, Zach, as most people know or may not know, Medicare does not cover dental, vision, or hearing in most limited instances. So, for instance, dental insurance: Medicare covers nothing dental, most of these Medicare Advantage providers are giving individuals either a dental allowance in a given year or in some instances are actually offering them dental benefits through these plans. Vision: another thing, eye exams, lenses, frames, things of that nature, Medicare doesn't cover. So, a lot of these providers are g
Some of the highlights of the show include:  The two most common times Medicare beneficiaries are able to make changes to their prescription drug coverage The downfalls of not selecting drug coverage What Zach and Nick do to ensure their clients get the right prescription coverage The differences between the four different tiers of Medicare Part D prescriptions The four different stages of prescription drug plans What the maximum deductible is for 2020 How prescription drug plans operate a lot like car insurance What the Medicare doughnut hole is and why it’s a bear for so many people Why beneficiaries are most likely to complain about Medicare Part D vs. other types of Medicare What patients should do if they are prescribed a drug that isn’t on their plans Why it’s important for Medicare beneficiaries to choose a national drug chain as their pharmacy What Aetna has in store for 2021 What the process of enrolling in a prescription drug plan looks like And more! Quotes“These drug plans are regulated by the government and Medicare, and there's only certain election periods throughout the year that people can make changes or elect different coverage, so we get complaints about these plans non-stop throughout the year.” — Nick“Your Tier 1 drugs are typically going to be the most inexpensive in most cases. Lots of drug plans offer these drugs free of cost. Tier 2 are going to be preferred generics in a lot of cases or non-preferred generics that are a little more expensive but still relatively inexpensive; Tier 3 are going to be your brand name drugs, and Tier 4 are going to be your specialty drugs, like cancer drugs.” — Nick“You're going to pay the full cost of your prescriptions until you get through the deductible phase of your prescription drug plan.” — Nick“The reason the doughnut hole can be such a bear is for people that have higher, more expensive medications, their cost-sharing within this period goes up pretty substantially.” — Nick“We're going to be able to tell you when to expect to hit that doughnut hole, or if you're going to hit it at all, or when you hit that catastrophic phase moving forward there.” — Zach“We always try to make sure when we're running PDPs for our clients, you know, making sure—a lot of them like those little local drugstores; we try to get them to at least check the big chains out there in case they do travel.” — Zach“The key is always to choose a preferred pharmacy for lower drug costs. That's always the key.” — Tausha“CVS is now allowing patrons to use PayPal, which I think is pretty cool. And then possibly in the future, they might be able to use Venmo as well.” — Tausha“I just really wanted to just highlight the support that CVS Aetna has given around COVID-19. We waived all COVID related copayments, and I think what's probably stands out the most for me is that we opened multiple COVID-19 testing sites throughout the United States where we kind of had those hotspots. And CVS acted quickly and implemented those hotspots to help with testing.” — Tausha Links:Aetna: https://www.aetna.com/TranscriptAnnouncer: Welcome to our fireside chat with Seniors Living Healthy, the podcast that helps prepare and educate you as you enter and live out your golden years. With over 10 years of experience, Nick and Zach are experts in the senior market and are here to help you live a healthy, full life. And now fireside with your hosts, Nick Keene and Zach Haire.Zach: Hello, and welcome to episode three of our inaugural season of Seniors Living Healthy. I'm your host Zach, and here with me, as always, is Nick.Nick: Hey, folks.Zach: So, this month's episode, we're going to talk about Part D of Medicare, which is your prescription coverage. Nick, what is our number one complaint?Nick: Prescription drug plans, no doubt, Zach. For whatever reason, these drug plans are regulated by the government and Medicare, and there's only certain election periods throughout the year that people can make changes or elect different coverage, so we get complaints about these plans non-stop throughout the year.Zach: That's right. With our hands being so tied, it's really, really hard. We can't tell the future. So, we can't see what people are going to be doing, taking prescription-wise down the road; really, all we can do is what's working for them there in October when those annual enrollment period comes. So, I know we've touched there briefly on enrollment period but, Nick, what are the two most common times people can enroll in drug coverage?Nick: So, the two most common times people can make changes to their prescription drug coverage is going to be their initial enrollment period when they first become eligible for Medicare, which is a three-month window both before and after their eligibility, and then also the annual enrollment period, which is that period from October 15th, through December 7th each year, that they're allowed to make changes to that coverage.Zach: Great. Yep, definitely. Yeah, those are our two most common times. There are a couple of different scenarios out there. If you guys want to subscribe to our newsletter, that’s something we'll, kind of, touch in that, here in the next couple days we'll be getting out to you guys, to see the different options you may have out there enrollment-wise. So, Nick, when we were working with people looking at things, what should our clients keep in mind when we're working with them to select a drug plan? Because like I said, we can't tell the future?Nick: Sure, absolutely. So, Zach, what we try to do is find the best drug plan and drug coverage for our clients at the time. Not only that, but we want to make sure people newly eligible to Medicare know about the downfalls of not selecting drug coverage, whether that's being penalized for not having credible coverage through Medicare prescription drug coverage, group insurance, or retirement benefits, whether that is someone who is not taking prescriptions and just thinks they don't need it, we want to make sure they're not getting penalized. We also want to make sure that folks have the best drug coverage for them. So, it's our job to ask questions to make sure that we're informed, that we take care of our clients.Zach: Definitely, yeah. Trying to put the client there first is always want to make sure we get what works best for them. So, moving forward there, looking at the different parts of the prescription plan, the first thing we want to cover there are the tiers. Prescriptions are broken down into various tiers, that kind of breaks them down into cost, types of prescription, things like that. Nick, you want to touch on those real quick, what the different tiers are, and what that means.Nick: Yeah, absolutely. So, Zach, the way the tier system works, and by the way, Medicare is who is dictating what prescriptions are in what different types of tiers based on their cost. So, your Tier 1 drugs are typically going to be the most inexpensive in most cases. Lots of drug plans offer these drugs free of cost. Tier 2 are going to be preferred generics in a lot of cases or non-preferred generics that are a little more expensive but still relatively inexpensive; Tier 3 are going to be your brand name drugs, and Tier 4 are going to be your specialty drugs, like cancer drugs, things of that nature. So, it's important to keep in mind that these drugs are placed in their tiers based on the cost of the overall prescription.Zach: Definitely, yep. So, now we've broken down the various tiers that prescriptions are in. We hear a lot about different phases—periods—when we're going through a drug plan. Kind of touch on those, that way people have an idea of where they're at moving down the line.Nick: Absolutely. So, the way drug plans are created, folks, is Medicare mandates that there has to be a minimalistic benefit to all prescription drug plans that companies offer, and they also mandate that all of the plans have four different stages throughout the plan. And that's going to be the deductible phase, the initial phase, the coverage gap phase, and the catastrophic phase. So, realistically, there's four different plans and they all have different thresholds, involves moving down the cycle.Zach: Gotcha. Yep, definitely. So, look in there, that first one there being the initial deductible phase, kind of, briefly touch on it, then how they move into the next phase, which would be your initial coverage.Nick: Sure. So, some drug plans have a deductible and some don't, Zack. So, the maximum deductible that's allowed for the year 2020 is $435. So, no drug plans can have a deductible higher than that for the year 2020. However, some drug plans alternatively, have zero copay at a additional premium a lot of times. So, the way that works is very similar to car insurance. The analogy we use: if you get in a wreck, and it's your fault, you pay your deductible before the insurance company pays. Same way here. You're going to pay the full cost of your prescriptions until you get through the deductible phase of your prescription drug plan. A caveat, too, to mention is some drug plans offer Tier 1 and Tier 2 drugs free of cost.Zach: Gotcha, gotcha. So, that gets that deductible phase. And, like you said, moving into the initial coverage phase, hitting that $4,020 limit there on the coverage.Nick: Yeah, and one thing to mention a lot of people see this number and their eyes pop. They think they're going to be responsible for over four grand out of their pocket before they get through the second stage of their drug plan. It's important to remember that this cost consists of the cost you pay and the cost the drug plan pays as well.Zach: Yeah, yeah. You're not paying $4,000 out of your pocket. So, then, looking there, the third stage is probably the most popular stage. Everyone hears a lot about—people complain a lot about it because you pay more for your prescriptions, but you're looking at that doughnut hole, or the coverage gap.Nick: Yeah,
Some of the highlights of the show include:  What Medicare Part B is and what it covers What the government considers “credible coverage” What happens when you have credible coverage and what happens when you don’t How much Medicare Part B costs on average How Medicare Part B costs vary on a person-to-person basis How chiropractic care can lead to a healthier lifestyle The impact stress can have on your spine and your organs What the Torque Release Technique is in chiropractic medicine How it’s never too late to begin treatment with a chiropractor  Some of Dr. Sara’s tips for staying in shape and living a healthy life as we age A brief primer on hospital indemnity plans and what they’re designed to cover How Nick and Zach help clients build hospital indemnity plans that meet their unique needs A few case studies on how hospital indemnity plans have helped Nick and Zach’s clients save money And more! Quotes“Think of Part B as covering everything outside of being admitted to the hospital. Medicare has no referrals. Lab work, physical therapy, CAT scans, MRIs, ambulance rides, emergency room visits if not admitted to the hospital, and homecare in a limited basis, are all covered under Part B.” — Nick“Medicare Part B has an 80/20 coinsurance, meaning Medicare pays the first 80% and you're responsible for the remaining 20%. The coinsurance takes effect after you have paid an annual deductible of $198 per year. Once the deductible is paid in full, you're responsible for 20% of all remaining charges.” — Nick“Part B of Medicare pays for diabetic testing supplies. Insulin, pills, diabetic medications are covered under Medicare Part D, but the testing supplies themselves, folks, are covered under Medicare Part B.” — Nick“Medicare is actually a pretty favorable insurance when it comes to chiropractic coverage. Typically, the only thing that is not covered within Medicare is examinations and/or X-rays if those are taken.” — Dr. Sara“The cool part is we are removing that pressure, and putting those bones back in the proper place. It allows your brain and your body to connect and actually function optimally, and as that happens, for one, a person gets out of discomfort while at the same time that means that the organ system is also thriving and starting to optimally function.” — Dr. Sara “The goal of our podcast is helping people prepare for retirement, whether that be 65, 70, 75 whenever that is.” — Zach“If you get up into retirement age, and you have all the money in the world, and you want to travel, you want to do all the things you want to do, yet you don't have your health, what do you have?” — Dr. Sara“I call it a Build-A-Bear plan, just because it is a very flexible plan. It's got a couple of different base parts of the policy you pick, and then it's got several riders that you can add on.” — ZachLinks: Freedom Chiropractic  Facebook  Instagram  TranscriptAnnouncer: Welcome to our fireside chat with Seniors Living Healthy, the podcast that helps prepare and educate you as you enter and live out your golden years. With over 10 years of experience, Nick and Zach are experts in the senior market and are here to help you live a healthy, full life. And now fireside with your hosts Nick and Zach.Zach: Hello, and welcome to episode two of our inaugural season of Seniors Living Healthy. Again, I'm your host Zach, and here with me is my co-host, Nick.Nick: Hello. Hi folks.Zach: This episode, we're going to go over Part B of Medicare which covers your outpatient care. So again, as I'm sure that you've guessed, this episode’s ABC of Medicare is going to be Part B, medical. So, once you turn 65, you're going to be able to elect to take this Part B as long as you don't have credible coverage, Nick, tell them what the government considers credible coverage.Nick: Credible coverage is determined by the level of coverage offered under the plan, and the number of employees covered by that plan. Among other things, if you are turning 65, or intend to retire soon, reach out to your HR benefits department to see if you will have credible coverage when the time comes.Zach: That's great, Nick. And so if they don't have that credible coverage though, and they don't take their Part B, and pass on it, why don’t you tell them what they're going to win by not having that credible coverage?Nick: Yeah, absolutely. Okay. So, once an individual goes eight months after they stop working, or employer coverage ends, whichever is first. They will be penalized by Medicare and that penalty is 10% of the full cost of the standard Part B premium, each year they go without coverage. Also, after that timeframe, there is a limited window, Zach, that a person can apply for Medicare benefits. It's what's called the general election period. It typically runs January 1 through March 31, with coverage beginning in July of that year.Zach: Gotcha. So, they let you elect it, kind of, sort of—Nick: On their timeframe. Yeah, you got it.Zach: Yep. Yeah. So, they tell you you don't have to take Part when you turn 65, but if you're not covered, you kind of have to. So, now that we've covered how you get your Part B, what all is that Part B going to cover for you once you receive it?Nick: Yeah, so Part B is outpatient coverage. So, folks, you can think of Part B as covering everything outside of being admitted to the hospital. So, meaning any type of services outside the hospital that are medically or Medicare-approved are covered under Part B. Some of those common services, Zach, we see things like doctor's visits, whether primary care or specialist—Zach: We're going to have to have a referral to see those specialists though?Nick: Oh, great question. We hear that quite frequently. Medicare has no referrals. Absolutely. Lab work, physical therapy, CAT scans, MRIs, ambulance rides, emergency room visits if not admitted to the hospital, and homecare in limited basis, are all covered under Part B.Zach: Great, great. So, now we know what they cover. We had that deductible on Part A we talked about last episode. Is it similar here with Part B or, kind of, how—what are they going to cover for us?Nick: So yeah, great question, Zach. Medicare Part B has an 80/20 coinsurance, meaning Medicare pays the first 80% and you're responsible for the remaining 20%. The coinsurance takes effect after you have paid an annual deductible of $198 per year. Once the deductible is paid in full, you're responsible for 20% of all remaining charges. And remember, just like Part A, Part B is a nationwide program designed for Medicare beneficiaries; no networks associated, and just like you said, no referrals necessary.Zach: Great, great. So, as we know from last month's episode that Part A, we paid into when we were working. So, Part B, we elect to take it, we haven't paid anything to it, yet. Nothing in life is free. How are we going to get that covered?Nick: Yeah, so absolutely. So, you're right. Nothing in life is free. This is a topic we run into quite frequently. One of the first questions people ask is, “What's it going to cost? I'm new to Medicare, what's it going to cost?” So, the answer is very simple: it differs. There is a standard Part B premium, that is $144.60 for the year 2020, however, the amount people pay varies widely. Some individuals pay nothing for Part B, some individuals pay the standard premium, and people making over $500,000 a year actually are paying $491.60 per month, Zach, so it varies quite differently. Most of these premiums begin the first month your Medicare goes into effect, and reach out to your local social security office to figure out what your Part B will cost you if that's something you're worried about today.Zach: Gotcha, that’s great. So, I know we talked about the quick overview of what all Part B is going to cover, hit some highlights there, but I know there's a few things out there that Part B covers that not a lot of people know, or people use them on a daily basis and knowing that Part B is going to cover that's going to be a huge help for them. You want to run through those for us real quick?Nick: Sure. So, the two common services that there are a lot of confusion about what are where it's covered are durable medical equipment and diabetic testing supplies. I know you and your clients, Zach, you've been doing this for a number of years, this is a question we get asked all the time. “Who pays for my diabetic testing supplies? Who pays for my strips, et cetera?” Very simply, Part B of Medicare pays for diabetic testing supplies. Insulin, pills, diabetic medications are covered under Medicare Part D, but the testing supplies themselves, folks, are covered under Medicare Part B. And then the other one there, Zach, is durable medical equipment. So, that's nebulizers, oxygen tanks, wheelchairs, crutches, you name it. All the medical equipment is also covered under Part B, meaning after the $198 deductible is met, clients are responsible for 20% of all those costs.Zach: Definitely, yep. That's a big part there with that Part B, what all it covers, especially those diabetic testing supplies. That is probably one of our top two or three questions we do get.Nick: Absolutely, absolutely. So, in a nutshell, that's Part B.Zach: Hello, and welcome back. We're here on the phone with Dr. Sara with Freedom Chiropractic here in Knoxville. How are you doing today, Dr. Sara?Dr. Sara: I'm doing wonderful. Thanks for having me on.Zach: That’s good. Thank you so much for joining us. Like I say, we're going to jump on in here with our interview part of our segment. And so we have Nick, as well, is here with me, so he's going to get the ball rolling for us.Nick: Sure, absolutely. So, we'll jump right in Dr. Sara. So, first of all, our first question for you would be what does Medicare cover when it comes to chiropractic care?Dr. Sara: Yeah, that is the favorite question from everybody, which is amazing. Medicare is actually a pretty favorable insurance when it comes to chi
Have a listen to learn: What Medicare Part A is  The three different groups that qualify for Medicare Part A What Medicare Part A covers and what it doesn’t cover How much Medicare Part A costs How Medicare doesn’t have any networks or referrals for any physicians or medical facilities and what that means for Medicare patients How Medicare Part A covers 60 days of hospitalization and what happens on day 61 and beyond What happens when you keep working after age 65 and the associated insurance implications The options individuals who don’t qualify for Medicare still have The services BenchMark Physical Therapy offers for Medicare patients The most common kinds of ailments BenchMark sees in Medicare patients The kinds of clients Parkwest Physical Therapy sees each day Tips for how seniors can succeed with physical therapy activities What “wrinkles on the inside” means How recovery care is the favorite product that Nick offers and why And more! Quotes“If an individual has worked 40 quarters or 10 years and paid into Medicare, traditionally via payroll taxes, then they will automatically qualify for Part A. They will receive Medicare Part A on the first day of the month of their 65th birthday with one exception: if their birthday is the first day of the month, they get it the month prior.” — Nick“In a nutshell, Part A of Medicare is hospitalization insurance for individuals on Medicare.” —Nick“Keep in mind that Medicare is a nationwide program. So, Medicare beneficiaries, whether from California, North Carolina, Michigan, to Florida all have the same program.” —Nick“As we get older, our system just doesn't do what we tell it to do. Our brains try to tell our body what to do, and it doesn’t react the way it did when we were in our teens.” —Matt“Physical therapy is a commitment. It's a time commitment. It's a financial commitment. It’s a lifestyle commitment.” —Matt“I think the biggest hurdle for a lot of people is that it's so new. You're doing things that you've never done before. Everybody's gotten their routine, and some of the older population, they've been in that routine for 50, 60, 70 years. And so, turning things in a different direction is a little bit more challenging.” —Matt“You always want to wear loose clothing because you're going to be doing things physical.” —Kaitlin“Statistics say the average cost in a nursing facility of some sort is $72,000 per year. I would say there's a good chunk of people out there, especially in the market we deal in, that if you're retired, that $72,000 is probably pretty tough to come up with.” —ZachLinks BenchMark Physical Therapy:  Parkwest Physical Therapy Centers for Medicare & Medicaid Services Senior Benefit Inc. TranscriptAnnouncer: Welcome to our fireside chat with Seniors Living Healthy, the podcast that helps prepare and educate you as you enter and live out your golden years. With over 10 years of experience, Nick and Zach are experts in the senior market and are here to help you live a healthy, full life. And now fireside with your hosts Nick Keene and Zach Haire.Zach: Hello, and welcome to episode one of our inaugural season of Seniors Living Healthy. I'm your host, Zach, and here with me is our co-host, Nick.Nick: Hello, folks.Zach: This month's episode, we will go over Part A of Medicare, which is hospitalization. So, as I'm sure you've guessed, this episode’s ABC of Medicare is going to be Part A, hospitalization. Most people are going to get that the month they turn 65 with a few exceptions, so we're going to jump right in. And Nick, why don't you tell us how an individual gets that once they turn 65.Nick: So, if an individual has worked 40 quarters or 10 years and paid into Medicare, traditionally via payroll taxes, then they will automatically qualify for Part A. They will receive Medicare Part A on the first day of the month of their 65th birthday with one exception: if their birthday is the first day of the month, they get it the month prior.Zach: Thanks, Nick. So, with that one exception, is there any other kinds of exceptions out there to Part A, how somebody can receive it, and when they can receive it?Nick: Absolutely, Zach, great question. So, if an individual doesn't qualify themselves for Medicare at age 65, they can qualify off a spouse, whether alive or deceased. Also, if an individual is under 65, but has been on disability, and received benefits for 24 months straight, they can also receive benefits, and then the third situation would be if individuals have been diagnosed with End Stage Renal Disease or ESRD, or Lou Gehrig's disease, they can also qualify for Medicare.Zach: Thanks, Nick. So, now we know how someone gets Part A; when they get it, how they can get it, what's it going to cover for them out there, once they receive it?Nick: So, Medicare Part A is listed as covering semi-private room and board, general nursing and miscellaneous services and supplies. So, in a nutshell, what Part A of Medicare is, is hospitalization insurance for individuals on Medicare. So, the way Medicare Part A works is it is designed based on a benefit period of 60 days, and when one is admitted to the hospital, they have a Part A deductible that they are responsible for, which is $1408 each 60-day benefit period.Zach: Now, is that deductible going to change depending on where they go to the hospital? You know, if they're out of town, they go to the hospital, is it going to be different? Are they going to have—how does that work for him?Nick: Yeah, so great question. Keep in mind, Zach, that Medicare is a nationwide program. So, Medicare beneficiaries, whether from California, North Carolina, Michigan, to Florida all have the same program. So, as long as they qualify for Medicare and it's in place, there are no networks or referrals for any physicians or medical facilities.Zach: Perfect that makes it nice being able to go wherever you need to go to get the [crosstalk] you need.Nick: Absolutely. Absolutely.Zach: So, in that 60-day period of care, when that 60 days up, does it start over again? How does that work? Break that down a little bit more for us.Nick: Yeah. So, the way the benefit period works, Zach, is the 60-day benefit period starts when an individual is first admitted, and continues as long as someone is receiving services, whether in the hospital and/or medical facility: things like skilled facility care. So, when they're admitted originally, they pay a $1408 deductible that covers them whether they stay in the hospital for continuous 60 days, maybe they leave the hospital halfway through, go to a skilled facility care then come back into the hospital: they're still covered under that same benefit period.Zach: Perfect. So, once that 60 days is up, what are they're going to get them for after that?Nick: So, Medicare has defined benefits, Zach, beyond day 60, that dictates how much someone on traditional Medicare is responsible for. So, if an individual is continually admitted, whether in the hospital or and skilled facility care, beyond day 60, day 61 through 90 will cost an individual $352 per day.Zach: That's a lot. Per day especially.Nick: Yeah, it can add up, but more importantly, if an individual is in there continuously beyond day 90, they have what's called 60 days of lifetime reserve coverage. Under the 60 days. They are responsible for $704 each day.Zach: Talk about a punch in the gut there, with that those prices.Nick: Sure, absolutely.Zach: So, looking there at it, Nick, let's say that I am getting ready to turn 65. I'm still working, or over 65 and continue to work. You have to take Part A, or can I just keep rolling with my company's group insurance?Nick: Yeah, great question. So, we field this question continuously as you know. With over 10,000 people turning 65 each and every day, people are constantly asking, “What do I do? I keep my group insurance, do I drop my group insurance, go on Medicare?” The simple answer is you have the ability to keep your group insurance without going on Medicare Part B. However, for today's topic, Medicare Part A is automatic.Typically, you've paid in throughout your career in the form of a payroll deduction, so the month you turn 65, you're automatically enrolled in Part A. One thing to know though, Zach, is if someone has group insurance, and they're going to continue doing it, they need to ask their HR benefits department, whether they will have Medicare as their primary, or whether they will have their group insurance as their primary. And one of the main things that dictates that, is the number of employees covered on that group insurance plan.Zach: Great, great. So, Nick, I know—kind of talked a lot about Part A, kind of getting it set in there. One of the things I wanted to point out there is, if you haven't worked your full 40 quarters yet, you are able to draw off your spouse. That's possible, but if not, someone that’s, let's say they don't have 36 quarters, and they're turning 65, so they're going to have pay for their Part A, are they still going to be able to continue to work and then, when they get those last four quarters off, quit paying for that Part A?Nick: Yeah Zach. So, let me give you a good answer to this question. For individuals that don't qualify for Part A of Medicare, they have the ability to purchase Medicare directly through Medicare. So, that is all based on the amount of hours they have worked and paid in throughout their life. So, for your example, if they worked 36 quarters, or nine years and paid in, they're responsible for four more quarters or a year before they qualify. They would have the ability to continue working, paying into Medicare while also funding Medicare Part A where they so wish.Zach: That's one of those situations where we refer somebody to go back to work.Nick: Yeah, yeah. It's good for the soul they say. But long story short, Medicare Part A is hospitalization. Different individuals qualify; covers when you're admitted to the hospital, Zach.Nick: Al
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