Podcast Episode #15: Medicare Q&A

Anna: You know how every election year your phone rings off the hook with robocalls from candidates? That’s the worst, right? Did you know that when you turn 64, you’ll be getting robocalls about Medicare? Well, hang up! Don’t engage. There’s a better way to learn about enrolling in and understanding Medicare.

Anna: Welcome to Navigating Universe, the podcast for people caring for their aging parents. I’m Anna Gelbman Edmonds your host. As someone who’s been working remotely for over a decade and loves it. attending any event has to be what my friend April and I call pantsworthy. That means putting on real clothes and makeup to be presentable in public. But every once in a while I force myself to attend events out of courtesy or loyalty to a friend.

And that’s what happened last year when I agreed to attend my friend Paula’s Monthly Wine and Learn event. The topic was Medicare, which sounded like a real snooze fest to me. But I like Paula wine and networking with the other guests at her event. So I went. And that’s where I met my guest, Caroline Ward, who’s an insurance advisor specializing in Medicare and was the guest speaker that evening.

Caroline, welcome to Navigating in Reverse.

Caroline: Hi, Anna. I’m glad to be here.

Anna: Well, we’re happy to have you. So I know that was kind of a backhanded compliment, but that was kind of an interesting night because actually a couple of years prior to that, I attended one of hers on Social Security, which was an even bigger potential snooze fest for me. And it turned out changing my life. So I’ll let you proceed telling listeners what were you presenting exactly. Why were you there. And what was my reaction? Because I didn’t really know you then. I knew you by sight, but I didn’t know you personally that night.

Caroline: That’s right, Anna. And you are a memorable person because I remember you. I was there speaking on the subject of Medicare. Avoiding common mistakes. I call Medicare an animal. It’s very complex. And so even the most intelligent person who has done a lot of research is not going to always get Medicare right. And so what I love to do as an insurance advisor specializing in Medicare is develop workshops, seminars on topics of interest so people like you who would rather snooze might pay attention.

So I remember you did pay attention that night and you came up and said, Hey, I’ve never heard this before. People have to hear this. You’ve got to get this word out. So you were very encouraging to me, Anna.

Anna: Well, thank you. Because when I say snooze fest, it’s not that it’s boring per se. It’s just too big. And people that are creeping up on those things that they need to pay attention to or are out of courtesy attending are thinking “who wants to dive into this huge topic?” I’d waded through it with my mom. I didn’t have to do a lot with her, but all these forms would come in, all these EOBs, and it was endless phone calls we’d get. I was like, “I don’t even want to deal with Medicare.” And my brother had to deal with most of it. I just didn’t want to get involved.

But I saw how complicated it was through your presentation. And I understood it. That was the part in the presentation that caught my attention. “Oh, that’s what part A and part B part are!”  None of that made sense to me before. So that being said, I now pay attention when people are talking about Medicare.

So the reason at the top of the show, I said, don’t answer the phone when those robo calls come in is that I don’t know who those people are. And it’s super important that you not just enroll in Medicare without knowing what you’re doing. Right.

Caroline: Exactly.

Anna: So how does someone find someone like you or actually you? Can you work with anybody in any state or you only licensed in South Carolina

Caroline: Yes, I can be licensed anywhere. I simply find someone in a state and apply for a license.

Anna: I know three people who specialize in Medicare. You’re. You’re only one. You’re the first one I met. But since then, I’ve met two others. So how are you different than the people who are making the robo calls?

Caroline: That’s a great question because I am much, much better than those people. And I tell folks to don’t answer the call. And if you do, don’t talk to them because they will give you misinformation and even enroll you in a plan that’s going to cost you a lot down the road. And it’s hard to get out of a plan once you get in it.

I got started a few years ago. I was in the insurance industry and wanted to really do something that made a difference that I was heartfelt. Long story short, got into Medicare and then, of course, COVID entered the world and I was getting ready to have a ribbon cutting. And so I delayed that nine months.

So it’s like having a baby. I was pregnant with Medicare for nine months, where I studied, studied like everybody else did. We weren’t going anywhere. So my goal was to become an expert in knowledge. I’ll never call myself a medicare expert, but I will call myself a specialist.

Anna: Okay.

Caroline: You can’t know everything about Medicare, and when you do, it changes. So there are very strict requirements for people who are involved in this market. I can’t call myself a medicare agent that’s not compliant. So it’s kind of tricky.

Anna: Because you would be representing Medicare.

Caroline: Exactly. So I’m tricky when I introduced myself to someone. So there’s a lot of studying and I just dug my heels in and I said, “I want to be educated so I can educate others.” That’s kind of how I get my name out there. My sweet spot is giving these presentations which you attended.

And we have an open enrollment coming up every fall.

Anna: What does that mean? Open enrollment?

Caroline: That is when if you have a medicare plan, a medicare Advantage, original Medicare Medicare supplement, you can make a change into a different plan for the next year. Sometimes you have a plan and it doesn’t really work well for you, so you’re not stuck.

Anna: If your circumstances have changed.

Caroline: Sadly. So it’s a great time of year for agents. It’s a seven week period of time from October 15th through December 7th every year where the gate opens and anyone already on Medicare can make a change.

Anna: So that’s new enrollees, too.

Caroline: Plus new enrollees. But throughout the year, we’re looking for people turning 65 or retired. Right after 65, That’s kind of the market that I work for. And there’s 10,000 baby boomers every day who are turning 65.

Anna: Right.

Caroline: And we’re not going to run out of those for a while.

Anna: So that’s the whole reason behind the magazine and the podcast. I mean, this is the Baby Boomer’s time and they are a humongous generation; and they’re just now entering their senior years.

Caroline: Exactly the beginning. Exactly. So the challenge for someone in the Medicare space is to get your name out there. It’s very competitive, but it’s like any kind of sales. You develop your own style. I chose to use grass work, marketing and networking. I did do something at the beginning in a highly recommend. Now I’m talking to agents is you have to invest in yourself, invest in your business, just as you know, starting a magazine and a podcast.

Anna: Okay. So I have a question. When I’m watching TV, I’m always seeing these commercials for Medicare and all they ever talk about is Medicare Advantage. But I hear rumors in the background from people I talk with that they’re pushing that for a reason, which is probably not a good reason. So can you clear the decks for us and maybe you need to back up what is Medicare Advantage and what are the other options?

Caroline:  That’s an easy answer. You have three choices.

Anna: Okay.

Caroline: Three choices with Medicare, you narrow it down. You have original Medicare that’s your part A and B. A is hospital and skilled nursing, and hospice. B is medical, all non-hospital. So you have A and a B. That’s called original Medicare. You can start with that. If you want a drug plan, prescription drug, you can add a D.

D is Optional. Your second choice is you get your original Medicare. You can add a medicare supplement. You just mention that and a part D, yes or no? It’s optional. Your third choice is the Medicare Advantage. That wraps it all together. Your A, your B, your D, It gives you your bundling. It’s a …

Anna: Bundle, like your cable bill!

Caroline: A bundle. You also get dental vision hearing over the counter pharmacy, shopping, transportation. You get all the goodies.

Anna: Okay.

Caroline: And there’s really not a catch to it. And if you sit down with me for a consultation, you’ll understand Medicare Advantage is much more like the health insurance we always have had during working years. But it’s better because you don’t have this deductible that you have to reach before the plan pays. It starts paying day one.

There’s always an out-of-pocket limit. So when I work with my clients, I say “how’s your pocketbook feel? You know, what are you comfortable with? If you have a lower limit, you’re going to get lower benefits. If you don’t mind having a higher limit, you can get some excellent benefits” and people like that. Right now, Medicare Advantage is outselling Medicare supplement.

There’s a reason why people are on both sides of that coin. And even the professionals who market these plans are on both sides. I’m on both sides. I explain to my clients how each one works and let them choose.

Anna: There’s not a good or bad.

Caroline: Exactly, exactly. Is what fits your lifestyle, your health issues and your budget. Those are the three things that we look at.

Anna: But they only advertise Medicare Advantage. That’s all I ever see them advertising.  And so I’m just thinking, oh, there’s got to be something about this that we don’t want.

Caroline: No, what you need to know about the advertising is they’re promising you a part B rebate right now. A part B is  $164.90. If you’re on Social Security, that’s going to come out of your check. It’s hard to get away from paying that part B unless you’re on financial assistance programs for lower income.

Anna: Sure.

Caroline: So everything you’re going to get is Part B, a refund, you’re going to get free groceries, you’re going to get $4,000 in dental. So when you call the number they say, let’s see if you qualify. If your zip code qualifies because plans are set up per zip code, but that’s not what qualifies you. It’s your income status. So about 5% of the population qualifies for all these benefits. Oh, so everything they say is true. It’s not true for everybody. That’s what I tell my people.

It’s very deceptive because they just want you to call. Because they are so good that they have gotten my highly educated clients to switch on the phone. Really. And I have to educate. I love this word educate, right? When I find a new plan, I say, do not change your plan over the phone. Even if the carrier calls, you don’t do it because that’s not the way it’s supposed to be done. Say, “I have an agent. I’ll talk to my agent.” I get fired up over this subject.

Anna: So there are other agents who sell health insurance, right? Because I have one of those, right? You probably know him but we’re not going to mention his name, not this time. But anyway, that’s not the same as a medicare specialist. He could be a medicare agent, but he isn’t necessarily so. What I’m telling people is I sat through this presentation. I wasn’t the least bit interested in Medicare at the time, but I was so intrigued by how much understanding I got of it that it’s worth you giving Caroline a call. Of course, all her contact information will be in the show notes, a link to her website. That’s not a problem. Or if you have your own insurance agent, maybe they can recommend somebody that they work with that you would trust.

You don’t have to go on my word, but I’m a pretty trustworthy person. So yeah, a medicare specialist is super important. Don’t just make a change because somebody told you to or the TV was screaming in your ear. Right?

Caroline: Exactly.

Anna: Okay. We’re going to take a short break here. Word from a couple of our sponsors and then we’ll be right back.

Anna: Okay. We’re back with Caroline Ward. She actually has her own company called Ask Caroline and she is a medicare specialist. I’m going to take a second and do one of my free commercials for the lovely Paula Sabbagha, who I mentioned at the top of the program. That’s S A B B A G H A. She is a financial advisor with Merrill Lynch over at the Bank of America building downtown. Both Caroline and I know Paula very well. And that’s your free commercial. Paula, we love you.

Ok. Back to Medicare. What about people who are over the age of 64 or 65 or getting ready to turn that age and are still working? And so maybe they have insurance with their employer or maybe they’re paying for their own insurance. What do you say to those people?

Caroline: Great question. So if you’re turning 65, that’s when you first become eligible for Medicare and you’re going to continue working in a job that provides you with health insurance. You have the option. And what I do is I sit down with people and let’s look at look at the cost and the benefits of the health insurance you have.

Let’s compare that to your Medicare options and let’s see what you think is better for you. 90% of the people stay with their group health insurance because they’re comfortable with it. They know it. It works for them. The other 10%, they’re happy to change. If you have a spouse who’s on your plan, that’s a whole other scenario.

But this is this is something to remember: the H.R. departments don’t always get it right.

Anna: Again, they’re not Medicare specialists.

Caroline: Yes. If your employer has 20 or more full time employees, they are legally required to continue giving you their health insurance.

Anna: Okay.

Caroline: The magic number is 20 or more. If your employer has under 20, they’re not legally required. They can then tell you you’re Medicare age and we’re going to drop you from our health insurance and you’re going to be responsible for your own Medicare.

Anna: Do contract workers count or only full time employees.

Caroline: Employees; full time employees who are receiving those benefits. What I find is most employers with under 20, they’re not going to cut your health insurance because they don’t want to lose you. So that’s the law.  So if you’re working, you can still sign up for a part A, which is hospital– that’s going to be at no cost.

Anna: Okay.

Caroline: Again, 90% of the workers, if you’ve worked ten years and paid into the system for 40 quarters, part A doesn’t cost you anything.  So if you’re working, you can sign up for Part A that just gives you extra money toward a hospital bill.

Anna: Okay.

Caroline: In the hospital, there’s one catch to that. If you are contributing money to an HSA account through your employer.

Anna: What’s an HSA?

Caroline: It is a health savings account where they take money out of your check pretax. You can use that towards your medical bills. If you’re contributing to that, you cannot have Part A. It’s just one of those weird Medicare rules.

Anna: Because they have to have those. [laughter]

Caroline: So let’s say you turn 65, you’re Medicare eligible, but you’re still working. You have health insurance. You can leave that health insurance at any time voluntarily and go on to Medicare without any enrollment penalty. Okay. People are really worried. If I don’t get Medicare at 65, I’m going to get penalized.

Anna: And you don’t have to wait for open enrollment. That’s a life change.

Caroline: Right. This is your choice. You’re voluntarily giving up your employer health insurance. So at any time in the year, you can do that. It’s important to know.

Anna: Okay. Well, that’s interesting.  So the other thing my audience are actually most often the caregiver versus not the senior. And like I said, I had to dabble in Medicare. I would get the phone calls and stuff for my mom. My brother had to handle the the administrative side of it, the money and fighting with them if there were any fights. What do caregivers need to know about Medicare for their parents?

Caroline: Great question because I work with a lot of folks who are taking care of their parents and sometimes they have just received this responsibility because the parent’s health is declining and they start looking at the finances and they see these premium the growth. They’re seeing the Part B coming out of a Social Security check. That’s understandable. But they might see $300 a month coming out of a bank of a account for health insurance.

And so they’re freaking out. Why are we doing this? So I always recommend if you’re put in this responsibility to care for an older loved one, make sure you understand how their Medicare insurance plans are working because there are still options. And as a person gets older, if they’re on a medicare supplement, which is excellent. Their premiums could be over $300 a month.

Anna: Right.

Caroline: And if their premiums per year are higher than an out of pocket cost on a medicare Advantage, it’s a good time to look at making a change.

Anna: Okay. And I will say there were a couple of times I would be on the phone with Medicare for whatever reason, and darned if they aren’t the nicest people in the world, which is very deceiving because I didn’t always understand what they were talking about. So from my point of view and my experience, I will say if you have questions, there’s nothing wrong with calling Medicare. But…

First of all, they’re going to spin it the way they want to spin it. I would again suggest that you call a medicare specialist and get a second opinion. So I don’t know if you agree with that or not, but it’s like calling the DMV and they tell you one thing or that you email them. Now, they’re pretty good at that. But then you get down there and the information you got on the phone is wrong. And of course, you don’t have the 50 other pieces of paper to get whatever it is you went down there for, right?

Caroline: Exactly. So if you call Medicare, you’re going to get what I call a level one person answering the phone. Level one is brand new. They’ve been through maybe 30 day training. And they don’t know what the agent knows. And I sometimes have to say, you’re trying. I say, good try, but here’s the right answer. So they can only give you general Medicare information. They can’t give you any information specific to your situation.

Anna: Well, now I feel really smart that I saw through that at the time, even more so than now, cuz I was totally Medicare ignorant. But I saw through that nonsense. And so then I would pick up the phone and not call someone like you. I’d call my brother and say, You gotta handle this dude! [laughter] Or I would just scan the documents and say, “This is your problem, buddy.”

Caroline: Right.

Anna: It didn’t happen too often. We did okay with Medicare. As far as I know, I never heard him screaming. The earth didn’t shake when there was an issue.

Caroline: Right.

Anna: Anyway, all right. So real fast, before we wrap up, I heard you use the word penalties. And I know that you can rack up some penalties. What are a couple of danger zones?

Caroline: The Part D prescription drug plan.

Anna: Okay.

Caroline: Let’s say you turn 65, and let’s say you haven’t had group health insurance, so you’re excited to get on Medicare.

Anna: Okay.

Caroline: And you find out, oh, it doesn’t give me any help with my drugs. I’m going to have to go pay full price. But there’s a drug plan, but you don’t take any prescription drugs. I’m healthy. I don’t need drug plan. I don’t want one. It’s optional. However, four years down the road, if you get sick and you need some mighty expensive drugs and you want a medicare drug plan, you’re going to be penalized for every month you didn’t have it. And it’s a percentage of the average national premium. You know, they’re going to make it very clear.

Anna: Do you see my jaw hitting the table right now? Oh, my.

Caroline: Gosh, it did! Make sure you don’t break a tooth over there. And guess what? You’re going to pay that penalty for the rest of your life on top of the premium for the drug plan. You could pay $100 in a penalty for a $20 drug plan. Yeah, I see your jaw dropping again…

Anna: I don’t know what to say. I don’t know what to say. That’s highway robbery. That’s horrible.

Caroline: So when you sign up, if you don’t take drugs, just get a little $10 drug plan, okay? A little cheap one. And then if you need a better one later you  can up it.

Anna: This is what happened when I went to Paula’s wine and learn. I’m sure you probably said that, but I was focused on something else because I remember you said a lot of things that shocked me.

Caroline: It’s shocking to me as an advisor and I tell people, listen, I don’t like this either. My job is to explain it to you.

Anna: Right? But don’t shoot the messenger.

Caroline: Exactly. I said there’s a lot of this I don’t like, but I’m helping you. Remember? I’m trying to make you understand. To help you on the front end.

Anna: All right, well, our time is up, so I will ask you to let listeners know. How can they best get in touch with you?

Caroline: Well, you already mentioned the website. I have a little web page right now. I’m upgrading the website this summer. Very excited. Caroline at askCaroline.net. Go to AskCaroline.net. You go in there and there’s a simple place to put your question. Push enter and I’ll get it and I’ll respond to you right away.

Anna: Very good. All that will be in the show notes. And my guess is we’ll have you back because if if that was the one penalty, my guess is there are others. Anyways, thanks for being on the show. Very informative. I’m sure we’ll get some feedback and I will be talking to you soon.

Caroline: Thank you, Anna.

Anna: Thank you.

Anna: The Reverse podcast is written and produced by the F Suite LLC. All rights reserved. Our audio engineer is Andrew Haworth. Thank you for listening.