Welcome to “It’s My Turn To Care.” We know the challenges you face caring for someone with dementia. That's why each week we bring you tips, strategies, and most of all, support, as you navigate your role as caregiver. Let's get started. [00:15.6]
Dave: Hello. This is Dave Parks and you're listening to It’s My Turn To Care: Secrets for the Dementia Caregiver. I'm a certified senior advisor and owner of Home Care Assistance, and it's always our goal to provide you some tips and strategies, and things to think about, as you care for someone who's suffering from dementia.
Today, we have a very special guest. Of course, all my guests are special. We have Jack Townsend, and Jack is the principal and cofounder of Insurance Solutions USA. It's a locally family-owned and -operated insurance agency that provides a single-source solution for individuals and families and employers, and our subject for today, Medicare beneficiaries. [01:10.7]
He has been in for about 20 years. He and his team have been making everything simple and easy for their clients, and he takes time to get to know and understand his clients’ needs and objectives. I know this on a first hand basis as he's helped my family and some of my employees, and other clients I've referred to him maneuver through the world of insurance.
Really, his approach is not to sell or pressure his clients, but to help them make the best decisions for them and the beauty of his agency is they can shop almost all the insurance carriers to find the best solution for his clients. Really, at the end of the day, they're really just trying to educate those that they do business with. It's really built on word-of-mouth referrals for over the last 19 years, so he's got a lot of experience. [02:07.2]
He really understands his industry, in particular, the Medicare insurance market, which can be very confusing. That's why he's with us today because we want to try and help you maneuver through this part of care, which is very important.
Jack, thanks for coming to the world headquarters of Home Care Assistance, and welcome to the program.
Jack: Thank you, Dave. Proud to be here and appreciate the opportunity to visit with you today.
Dave: We're here to talk about and focus on Medicare. We know you have some other lines of insurance that you work with, but what I really about your agency is your understanding around Medicare because it's so much a part of the care plan when we're working with clients. Let's kind of start with when is it the right time for someone to come to you and talk about Medicare and Medicare insurance? [03:07.4]
Jack: Dave, generally speaking, any time is a good time. We get calls through all phases of Medicare pre and right at Medicare and post Medicare, but I would say maybe ideally as early as three months before someone turns 65. They have a window of time, three months before the month they turn 65, the month that they turn 65 and then three months after they turn 65, in terms of making a Medicare plan selection. So, they have a seven-month window.
Obviously, many people prefer to get early start on that and get it complete, but outside of that, we do get calls throughout the year to have just general discussions, strategy plannings and discussions, but certainly annually on an annual basis between October and December is what's referred to as a Medicare annual election period, and so it's really important that we have some conversations with our existing clients and any potential new clients during that time just to educate them of what's coming for the new year. [04:10.6]
Dave: One thing that I was thinking about as you were talking is, a lot of times, people who listen to this program, maybe they're in their forties or in their fifties, and they're taking care of someone. Maybe they’ve just started taking care of their loved one who maybe has declined a little bit and they're trying to maneuver through some of this, so they're looking at this going, Oh my gosh, this whole Medicare thing is overwhelming.
Could you help them, point them in the right direction of just understanding what they're getting themselves into, so to speak?
Jack: Yes, absolutely, and now that you bring that up, it's really interesting. We're seeing a trend over the last several years where the child, and they're in their forties or fifties but they're caring for their parents, or they've been placed in that position, so we do. [05:04.3]
We get the calls and they basically share with us they're very frustrated because of the confusion and so many pieces of mail, and when they try to maneuver and digest this stuff on their own, it's just very challenging and difficult. So, they do reach out to us. We're able to have some conversation and actually we're able to take some of the anxiety away because we really kind of start at the beginning and we just have a conversation and ask them, What, if anything, do you know about Medicare and the options available?
It's very interesting to hear the response, but as educated as some folks are in various areas of their life and in business, when it comes to Medicare, it's just not a bubble they live in, and so we find that they really appreciate somebody slowing down and just having a very common conversation to address what's out there, what's available, so that you can make some decisions as to how they want to proceed. [06:03.0]
Dave: Yeah, I think that'd be really valuable, because I know when I took over the care or when I was helping with the care of my dad, I was kind of the financial guy, so I was responsible for the Medicare and for all that kind of thing. Frankly, the only thing I liked about it was when I got something from the insurance company, I said, “This is not a bill.” It just seemed that that came and then the bill would come later, but when I got that, I always took a deep breath. Oh, I'm so glad this is not a bill.
But, anyway, okay, so let's talk a little bit about the Medicare beneficiary, the person that's actually covered. What's your approach when you first meet someone that's kind of going through this process?
Jack: Okay, that's a good question. Like I mentioned before, we just want to stop and just really kind of start at the beginning, so we understand where they are in their knowledge. We simply ask, What, if anything, do you know about Medicare and the options available to you? [07:00.7]
Then based on that response, it kind of guides us as to how we should proceed in our discussion, because we don't want to talk ahead of the client or over the client. We want to make sure that we're meeting them where they're at. So, we will start so far at the beginning where we just clarify and ask them, Do you know what Medicare Part A and Part B is? You know what, Dave? As far along as some people are in Medicare and having Medicare, it's interesting that there's a pause and they questioned their understanding.
Dave: Sure.
Jack: And so we start there and just kind of clarify that, and then they appreciate it. They seem to appreciate that. Then we let them know that there are other options in addition to original Medicare that are made available to them and each of these options are tailored for a niche market, if you will, and each performs similarly but also very differently. [08:01.9]
So, we want to make sure that we have that discussion and let them know—and I’ll say this for clarification. In addition to original Medicare, there is a solution where you can purchase a secondary insurance policy called a Medicare Supplement, and the original Medicare is designed to cover 80 percent of Medicare-covered expenses and the Medicare supplement offered by a private insurance company is designed to cover the other 20 percent.
We discussed that with them. We discussed that an original Medicare ID card and a supplement ID card cover medical expenses only, and they do not include prescription drug coverage. In addition, we would need to independently shop Medicare Part D drug plans.
Then, the other option for the consumer is a solution called Medicare Advantage Plans, and Medicare Advantage Plans are offered by a private insurance company as well, but it includes or embedded is Medicare Part A, Part B and Part D, prescription drug coverage. [09:09.8]
Dave: Jack, I can see where your services and people who do what you do are so valuable because, just in the short nine minutes we've been on, as you can get, there's a lot of information. A lot of information. Is it pretty easy to enroll?
Jack: It can be and it should be. We always advise clients, You have really three choices. You can go down to your local social security office if you're inclined and have a conversation face to face, and we hear good feedback from clients about that. The other thing that's very popular now is the website, SocialSecurity.gov. Simply go there and register, and elect your Medicare Part A and B.
Then the other option is by phone. We typically don't encourage that because there's a very long whole time obviously.
Dave: That’s a shocker.
Jack: It's a shocker. So, if someone's inclined to do it, that's fine, but the other two seem to be suitable. [10:05.7]
Dave: Can you enroll in a Medicare advantage plan through SocialSecurity.gov or is that only traditional Medicare?
Jack: No. That's a good question. You can only roll or elect Medicare Part A and Part B, and just for clarification purposes, Dave, Medicare Part A covers inpatient healthcare, okay, and Medicare Part B covers all outpatient healthcare, just for clarification.
Dave: Okay, very good. This is a loaded question because I get this question in my business a lot. How much does this cost?
Jack: That's another good question. It can vary. The answer is it can vary. Right now, in 2020, the standard Medicare Part B premium is $144.60 per month. However, based on income, somebody may pay lower than 144 or, if they had high income, they may pay more than 144. [11:04.8]
But let me clarify, Medicare Part A has no cost, in that the beneficiary is typically entitled to it. They’ve paid in their Medicare taxes during their working career, and so when they become eligible for Medicare, they do not have to pay for Part A. They only pay for Medicare Part B.
Dave: So, the taxes we pay is only for Part A.
Jack: That's correct.
Dave: Okay, now that's something I did not know, so I appreciate that, yeah, very much.
Jack: You bet.
Dave: You've touched a little bit on Part A and Part B, but I know there's Part C and Part D, and I don't know how many more letters of the alphabet are involved, but maybe you can talk a little bit about in a little bit more detail around each of the parts.
Jack: Sure, I'd be happy to clarify. As we've discussed, it starts off with Medicare. Yeah, it is an alphabet soup. It starts off with Medicare Part A and Part A is simply all health care services that can be rendered while inpatient in a hospital. We'll keep it simple. [12:04.5]
Medicare Part B is all healthcare service that can be rendered to a consumer on an outpatient basis, so that could include doctor visits, lab work, blood work, MRI scan. Everything that we can do as consumers on an outpatient basis would fall under Medicare Part B.
Dave: Okay, so Part A inpatient, Part B outpatient. Part C.
Jack: Okay, this is where it starts to get confused.
Dave: Sure.
Jack: When these Medicare Advantage Plans bundle Medicare Part A and Part B, and also Part D prescription drug coverage, which we haven't discussed, but when you bundle those together, the government, CMS, the Centers for Medicare & Medicaid Services, calls it Part C. We're in the confusion industry, Dave.
Dave: Yes.
Jack: We like to think in our office that we run a clarification business.
Dave: Let’s say the government is in the confusion industry and it's our job to help clarify. [13:02.5]
Jack: That's right. So, Part A and Part B. We've discussed Part C. Part D, that is a prescription drug benefit and that could be a standalone product for a beneficiary to purchase or it could be embedded in that Medicare Advantage Plan, but it's very important to understand the different letters, and what they do and how they apply to their health care needs.
Dave: I guess the government got lucky on Part D because D for drugs.
Jack: Mm-hmm.
Dave: So, that's where that does make a little bit of sense. Okay, so I can already tell there's a lot of options. Why don't you try to break down some of the basic decisions that people need to make as they consider all these options?
Jack: Okay, I'm going to keep this on a macro level. It really comes down to two essential choices, okay? A Medicare beneficiary can opt to, in addition to original Medicare, they can purchase that Medicare Supplement that I mentioned earlier. [14:04.3]
Let me clarify. The government calls their coverage Part A, Part B and Part C. If you buy or if you purchase a secondary insurance policy called Medicare Supplement, the insurance carriers call there's Plan A, Plan B -
Dave: Oh, great.
Jack: - and it goes to letter N, so there's a whole alphabet. Why are there so many letters and why so many different plans? Because each one of those Medicare supplement plans is designed to cover varying degrees of the 20 percent that original Medicare does not cover, so it offers the beneficiary or consumer some price point options for consideration.
I'll just say this. If someone chooses a Medicare supplement, kind of the question is, What am I getting? Okay, if I'm going to do this, is there a premium? Yes, there's a premium associated with it. If I spend the premium to get this supplement, what am I really getting out of it? [15:04.2]
We like to keep it simple in our office. We let the client know you're trading your premium dollars for freedom, choice and access. There are no networks. You're free to choose any doctor, any hospital that accepts Medicare. The coverage is nationwide. When you turn 65, you don't even have to answer any health questions, or let me say this—if you've been working and you have had employer-group sponsored insurance up until age 70 or something like that, when you come off your group insurance, you still can get the supplement without answering any health questions. That, in some cases, is very appealing.
Then foreign travel. Medicare does not cover foreign travel, but the Medicare Supplements do.
Dave: Okay, that’s something else I didn't know.
Jack: Not all of the supplements, but some do. Most of the popular ones do, so, yeah, that’s interesting.
Okay, so just to recap, probably Option 1 is for the beneficiaries to choose a supplement and a stand-alone prescription drug plan, and that's their program. So, they have three ID cards in their purse or wallet. [16:09.3]
Dave: Okay.
Jack: The other option is called a Medicare Advantage Plan, so we'll call that Option 2. A Medicare Advantage Plan is a single insurance company, a single ID card. It includes Part A, Part B and Part D, and so you would take that card or the beneficiary would take that card to the doctor, to the hospital and to the pharmacy. Right?
So, the question is, Okay, well, if I choose that path, if I choose that program, how much does that cost? It varies, but in major metropolitan areas, oftentimes it's a zero premium, zero premium per month, in addition to what they're paying for Medicare Part B that we discussed earlier. So, what's the tradeoff? If I'm not paying anything for it, what am I getting?
Dave: Nothing's free, right?
Jack: Nothing’s free. The way that program works is you would have, generally speaking, copays. You'll pay a copay for this, that or the other type of service, and then you do have an out-of-pocket maximum that, if anything dramatic happened during the year, you’d have a limit to how much you're exposed to. [17:13.8]
But oftentimes those are network plans, Dave. They're an HMO network or a PPO, and so you must really work with those contracted providers, so you wouldn't have as much freedom or choice or access as, say, the Medicare supplement.
But, again, in our observation, it really comes down to personal preference. We don't advocate one over another because both products exist for reasons and we want to make sure our clients understand what those options are, so they can make an informed decision.
Dave: Yeah, and we've had situations where I’ve always felt in most things, you get what you pay for, and if you are on a limited budget, that's going to kind of direct you in one way, but we have had some clients who have had a particular type of Medicare Advantage Plan and it became a little difficult to find them the medical care that they needed because of the network that they were in, that kind of thing. [18:15.1]
Jack: Yes.
Dave: So, there's a tradeoff. It feels to me that, essentially, you have two kind of broad choices -
Jack: Correct.
Dave: - one being kind of the traditional Medicare choice and the other one being the Medicare Advantage choice, and then there's decisions. Once you decide broadly what you're going to do, then there's a series of decisions you have to make down each path.
Jack: Yes, that is absolutely correct. We want to first make sure they understand the two paths that they can choose from. Once they choose a path, then we begin the work. We independently shop all of the Medicare Supplement carriers to determine which carrier is interested in that particular gender, age and demographic area, because it does vary and it's very interesting to see the landscape. [19:07.6]
All these insurance companies, and I’ll tell you, Medicare Supplement Plan G, for example, it's a very popular supplement. There are over 50 insurance companies that offer that contract and that is that Medicare Supplement is a standardized contract with the federal government CMS, and each of these insurance companies get to pick and choose which contracts they want to offer, and they get to pick and choose how they want to price that contract.
Our job is to independently shop that, which we have access to software to allow us to do this, unbiased software where we can see the entire landscape. Now, when we see that information, we can educate our clients as to, If you want this particular contract, generally, you want what you want, but you don't want to overpay for it.
When we share that information and how the carriers rank and their A.M. Best rating and financial standings, and also premiums, it allows them to make a comfortable decision as to which company to enroll with. [20:07.5]
Whether we're doing a Medicare Supplement analysis or even a Medicare Advantage Plan analysis, now, with a Medicare Advantage Plan, we definitely take into consideration their doctors, their primary care doctor, their specialist, because we want to make sure that all their doctors that are important to them remain intact, that they can maintain the continuity of care, and if we find some plans that work with all their doctors, then we line those up side by side, so we can compare and contrast, and then educate the client, and generally speaking, they choose the one that offers them the lowest cost, in general.
Dave: Sure.
Jack: Yeah, but they want to make sure that it's going to work and we want them to have a good experience if they make that selection.
Dave: Jack, what I'd like to do is, no pun intended, to separate these podcasts into Part A being one show for this week, and then could you come back next week and maybe have a Part B discussion? [21:10.0]
Jack: I’d be happy to.
Dave: Okay, so I appreciate that. But I do want to tell our listeners, in case they can't listen to next week's program, if they have more questions, how would they get in touch with you?
Jack: Good question. They can contact us by visiting www.InsuranceSolutionsUSA.com, or you can call or click. Call is (817) 756-1442. You can call or text to that number, or certainly go to our website InsuranceSolutionsUSA.com.
Dave: Great. Jack, thanks again for being our guest on It’s My Turn To Care: Secrets for the Dementia Caregiver. This is Dave Parks, owner of Home Care Assistance. I'm also a certified senior advisor, and we always encourage you to visit our website HomeCareAssistanceFortWorth.com, and our office number is (817) 349-7599 if we can be of service to you. [22:12.4]
Thanks again, and we'll have Jack on next week and we're going to talk some more about Medicare. Thanks so much.
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