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Understanding basic Medicare options is not enough to ensure proper coverage for your loved one. There are limited windows to make decisions in. Miss a window and your family member may have to go without insurance for a period of time.

And choosing the wrong plan could lead to thousands of dollars of out-of-pocket expenses for prescription medications. Getting the details right is critical to securing the health and well-being of your family member.

With so many moving parts, it’s a good idea to get help from a professional in the industry.

In this episode, independent insurance broker Jack Townsend discusses how to navigate the various enrollment windows and pick the right plan based on your loved one’s unique circumstances.

Here Are The Show Highlights:

  • Why getting the Medicare calendar wrong can leave your loved one without health insurance when they need it most (2:28)
  • How to enroll your family member in Medicare even when they missed the enrollment period (2:56)
  • What you have to know about changing plans when your loved one’s Medicare no longer covers their needs (5:35)
  • Why “Part D” may be the most important Medicare choice you make and save you thousands of dollars (7:53)
  • The surprising reason that your loved one’s current plan could be worthless to them next year (10:56)
  • Why brand loyalty could destroy your loved one’s health (16:11)

For daily 5-minute mind exercises, head over and like my Facebook page: https://www.facebook.com/hcafortworth/

You can also find additional support and resources by calling Home Care Assistance at 817-349-7599 or visit our websites https://www.homecareassistancefortworth.com/ and https://itsmyturntocare.com/.

Read Full Transcript

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 I am a certified senior advisor and owner of Home Care Assistance, and I want to welcome you to our program today, It’s My Turn To Care: Secrets for the Dementia Caregiver. We're always looking for tips and strategies, and just things to think about, as you care for someone suffering from dementia, and one of those things that you'll probably have to deal with is Medicare.

Last week we had Jack Townsend from Insurance Solutions USA come and talk to us about some of the basics with Medicare, the Part A, Part B, Part C, Part D, traditional Medicare versus Medicare Advantage. If you want to check out that podcast, please look at the previous podcast to this one. [01:12.2]

Again, Jack owns a company called Insurance Solutions USA. It's a family-owned business. They've been in business for over 19 years, and he really understands his industry in particular, the Medicare Insurance Market. He's more really of an educator than someone who's just trying to sell you some insurance and that's why we've partnered with him over the years to help our clients, our own family and employees.

We are honored to have him with us today. Jack, thanks so much for coming back for another program.

Jack: Thank you, Dave. We're honored to be here and pleased to be visiting with you today.

Dave: We've talked about a lot of information and it is a very big part of our lives and there's a lot to absorb. Let's kind of move along a little bit and talk about one of the big things with Medicare, enrollment periods. How many are there? How do they work? [02:14.3]

Jack: Okay, yeah. I'll see if I can clarify that for you and for our listeners today. There are actually several, so let's start at the beginning. There's something called the initial enrollment period and that's for folks that are turning 65. I had said in the previous podcast that that begins three months before they turn 65, the month they turn 65 and three months following turning 65, so it's really a seven-month window.

There's another enrollment period called special enrollment period, and that's for somebody outside of the traditional annual election period. They’ve had something shift or change in their world. For example, maybe they were employed, and they had employer-sponsored insurance and lost it, but they're over 65. Now they need to enroll in a Medicare plan. That would be considered a special election period, something else out of the handle, the open enrollment period. [03:13.2]

Another enrollment period is the general enrollment period and that is for folks that maybe missed the window. Maybe they weren't paying attention and, believe it or not, we still come across some folks that said, Hey, I was busy. I was working and I don't even feel that I'm 65 or turning 65.

Dave: I almost feel like I need to go ahead and put that on my calendar 90 days before I'm 65 and have an alarm go off.

Jack: Yeah, it's unfortunate, but sometimes we do get introduced to somebody that says, I just missed the boat. I missed it. I didn't enroll in time. What do I do?

There is something called a general enrollment period and it's between January I and March 31, and if those folks enroll during that time, their coverage starts July 1, so it does not start right away. [03:59.6]

Another enrollment period is what is so popular that’s called the Medicare Annual Election Period. This runs from October 15 through December 7, every year. All of your listeners will know because they will see the television commercials shift over and start advertising. They will see their mailboxes fill up.

Dave: Is that the Joe Namath commercial?

Jack: That’s it. It is the Joe Namath commercial. That's right. That's between October 15 and December 7.

Now, Dave, probably lesser known is something called an open enrollment period. Now, you notice I'm enunciating and using my terms specifically. The open enrollment is another period from January 1 through March 31. Let me explain what that is. Let's say, a Medicare beneficiary made a decision, enrolled into a plan and they get into the New Year, and they start to use it and it's not everything they thought it would be. They actually have regret or remorse about their decision. [05:02.1]

Recently, as it started in 2019, this enrollment period called open enrollment period, it allows the Medicare beneficiary to one time disenroll from their plan that they’ve selected and enroll into another plan. They can switch from one Medicare Advantage Plan to another, or they can disenroll from a Medicare Advantage Plan, go back to original Medicare and get a Part D prescription drug plan. Of course, if they want to buy a Medicare Supplement, they can do that at any time.

Dave: Kind of feels a safe harbor in a way.

Jack: It is.

Dave: Make one decision. You can always…there's an opportunity to change it under certain circumstances.

Jack: That's absolutely correct, yes.

Dave: Wow. Anything that has five enrollment periods feels like definitely there are opportunities for folks like yourself to help others maneuver all those choices. Before you even have to decide which plan, you’ve got to just figure out the right enrollment period it feels like. [06:06.2]

Jack: Yes, and we always just advise clients, look, you don't need to retain everything that we discussed, but we've been asking you to retain our phone number and contact information. Just lean on us. We'll help you.

Dave: Once you get to that right enrollment period, how does someone determine which plan is best for them?

Jack: Okay, that's the golden question. It's hard. If your listeners don't talk with someone like myself in the industry or business and they try to navigate it on their own, and I'm speaking in general terms, it is incredibly difficult because of the amount of advertising that they’ve received from insurance carriers, let's just say, personally in the mailbox.

We're certainly not supposed to do any solicitation calls, but oftentimes our clients tell me their phone rings and people are calling and soliciting, and I know it's frowned upon. Anyway, it still happens. [07:03.3]

We encourage them to talk with somebody us that is in the industry that is impartial, that can independently shop these carriers and plans to identify what might be suitable or educate the client, at least the landscape. People can handle the truth about things. They can't handle mistruth. We want to be very upfront and very honest, and very transparent, and when they see that landscape of, say, Medicare Advantage Plans or prescription drug plans, and their eyes open up and the lights come on and they say, Now I see. Now I understand.

Let me give you an example. One of probably the most challenging things for us in our agency is to do the right thing for the client in terms of shopping for their Medicare Part D prescription drug plan. Let me explain why. The insurance carriers that offer these Medicare Part D drug plans for 2020, there are over 25 insurance companies offering that product. [08:02.3]

Why so many plans? They’re all designed to do something a little bit differently, and so what happens is the insurance carriers renegotiate their contracts with the pharmaceutical manufacturers every year. What we do is we ask our clients that we obtain their profile and medication, so that the name, the form, the tablet, gel, cream, the dosage and the frequency that they take or use it, and then even their preferred pharmacy. Where do you like to fill it?

We have software that we can plug all that data in and it will shop all of the drug plans, and identify the lowest cost of ownership. When I say lowest cost of ownership, I mean all of the premiums and all of the copays for the whole year, and it sorts those 25 plans. It rearranges them from lowest cost to highest. Then it's amazing because we like to do this work in front of the client, if we can via Zoom or in person or whatever, but it's so gratifying because they see what we do. [09:05.1]

They see how we come to the conclusion, decision or recommendation, and they're blown away. Oftentimes I can read on their face they're puzzled and I’ll say, I can tell your thinking something. What do you think? and they say, Well…before talking with you, I kind of had another plan in mind. I’ll say, Oh, really? Okay. Which plan were you considering? and they will tell me and oftentimes I’ll scroll down the list and notice that in some cases… One stands out in my mind. It was about $1,100 more a year cost.

I asked the lady, I said, “Do you mind if I ask you why you were considering that plan?” She said, “It was a brand, a company that I was familiar with and felt comfortable with, and I saw the premium and I thought that seemed reasonable.” She said, “But I had no idea of the other part of the story and I'm so grateful that you shared this information with me.” I'll be honest, I mean, that's what gives us the gratification to do this. [10:00.4]

Dave: Yeah. I could see if someone had Blue Cross Blue Shield their whole life and then it's time to get Medicare. Does Blue Cross Blue Shield have a plan? If they do, that's probably what I’ll get. I've been happy with them for 30 years, but that may not be the best choice.

Jack: That's true. It may or may not, and I think it's worth the conversation. There's no obligation to talk to us, any of myself or any of our team. We simply want to provide information and value to our clients, so that they can make those informed decisions. If they choose to engage with us, we're thrilled to do that, but we want to earn their business year after year by doing that, doing that homework and advising them.

Dave: These drug plans, focusing on the Part D, it could be the best for them one year, but then, the next year, not necessarily.

Jack: Yes, that is absolutely correct. We always kind of plant the seed with our clients. We want to do an annual review where we want to provide an annual review for you, not to promote or encourage change. That's not what we're about, but we're about education. [11:09.3]

I’ll give you an example. One of our clients and she's been a client for a long time, we are actually friends and have become friends, she denied me one year. I reached out to her. I had a conversation. I said, “Hey, it's that time again to do an annual review. I'd like to review your prescriptions and Part D drug plans if you'd like,” and she said, “No, Jack, I don't want to make any changes.” I said, “Oh, really?” She said, “No, I'm very happy with my plan. It's been working great the last two years, but thank you so much.” I said, “Okay.”

Of course, I take very good notes, but what happened is, in June, the following year, our phone rang and she was upset and she was explaining to us that the pharmacy was trying to charge a great deal of money, somewhere in the $60, $65 for the prescription. I didn't know quite how to handle that, so I got back on my computer, looked at her file, looked at the notes and realized that I called her on a certain date and time. [12:06.5]

I said, “You denied me the ability to do an analysis. Do you mind if I do it live with you right now to determine what's happening?” She says, “Sure, go ahead,” so I did and the first thing I noticed was that our current drug plan was not at the top of the list in terms of lowest costs. I scrolled down to her drug plan, clicked on the details to look at a particular med and see what the specific copay was, and it was $67.

Dave: Right, yeah.

Jack: She says, “I know. That’s what the pharmacy is trying to charge me, but, Jack, I don't pay anything for it.” I said, “You're telling me you don't pay anything.” She said, “That’s right.”

I went back to the previous year's analysis and, sure enough, same drug plan, same pharmacy, same drug, she had a zero copay and now it's changed for that year to 67. Had I done the homework and the analysis, I could have advised her and she could have avoided that pain. [13:01.2]

I use that as my motivator to try to not accept no. When we offer to help, we really want to do the work, so that we can keep our clients in the most cost-effective solution here.

Dave: Right. When you're diagnosed with Alzheimer's disease or some form of dementia, you pretty much know what your drugs are going to be for the foreseeable future. It feels that what you do could be a lot of value to someone in that situation.

Jack: I think so, and just so you know, as I stated, we're not all about change, but there's many times that we do the analysis and we come to the conclusion that the drug plan that they're currently enrolled in is still the lowest cost solution for the upcoming year, and so we recommend no changes and that's well received. A lot of our Medicare beneficiaries are not pro to change every year, so, yeah. [13:57.8]

Dave: That's one of the things that I'm sure insurance companies, carriers, love, because when I was handling the Medicare portion of my parents' care, I frankly just didn't want to fool with it because I'd get these 30-page pamphlets or policy manuals, or I don't know what they were, and I'm like, There's no way I'm going to go through that and see if this is still the right plan for your parents.

The easiest thing to do is to just let it roll over and, frankly, I didn't know someone like yourself in the industry to where I could sit down with them on an annual basis and go through what was best for my parents, because what was best for me was just to let it roll over, because I wasn't going to spend the amount of time it took to understand 10, 20 different plans.

Jack: Absolutely. Everyone is busy in our society, and it's hard to slow down and have that space and time to do that and do it properly. Again, I think I'd like to think that's job security for us to be able to provide that. [15:03.5]

Dave: I think it is.

Jack: Yeah.

Dave: I definitely think it is, and what that kind of touches on, I just want to touch on this maybe once again, is that once you sign up for a plan, it's not something I'm stuck with for even a short amount of time if one of these enrollment periods come up or particularly in the long-term.

Jack: Correct. It's interesting. Most people, I feel today and certainly in the last 10 years, they’re becoming more and more educated. More and more information is disseminated and people are coming to understand that they can make changes, but we still talk to folks that when they turn 65, 10, 15, maybe even 20 years ago, they've stayed with the same plan the whole time. What happens, generally speaking, with that is those costs continue to rise to…normally they rise kind of normally, but then, at some point, they start to escalate and we find somebody that really just, hasn't looked at the market in a long time and, quite frankly, they're way overpaying for their coverage. [16:06.7]

So, we think it's a good idea to at least have a conversation annually and, if not, it's certainly every three to four years. It's a good idea just to go look and shop. Again, if you call somebody us and you get the service, and then it's up to you to decide what you want to do.

Dave: Sure, absolutely. What are some of the biggest issues, questions, the top things that when people come to you, you hear most of?

Jack: Okay, this kind of stands out and this seems to be trending, but as we work with folks and maybe as they're new and turning 65, and they're making their decisions for the first time and they're quite pleased that they understand, and they feel comfortable with their decision and they complete their enrollment, they turn around and ask us, Hey, now that I’ve enrolled, does that mean my phone will stop ringing or I won't get all the mail? [16:56.8]

And I have to explain, Unfortunately, that is a no. That's a firm no. No, these insurance carriers, they know you. They know your demographic and they're going to constantly bombard you, but I can assure you this—you've made your decision. You have peace over your decision. You can disregard any other communications that you're perceiving.

It's just interesting. They so wish they would stop receiving these solicitations once they make that decision.

Dave: Sure. Jack, we very much appreciate your being on It's My Turn To Care. Can you think of maybe if there was one thing you would want our listeners to take away from the last two shows, one or two things, what would that be?

Jack: I think maybe the one thing is don't go at it alone. Find somebody us or somebody us in the industry and develop a relationship that you can lean on and trust to have your best interests at heart. Just do an evaluation, ideally on an annual basis, to determine if you're still in the best program for you. People’s circumstances do change from time to time, and so it's a good idea to just evaluate that. [18:08.6]

I just really don't think I would wish it on anyone to try to navigate on their own. It's very difficult. So, find someone.

Dave: Sure, it sounds like I’ve heard you say this before. Don't necessarily trust a pamphlet that comes into the mail.

Jack: It is true. It is advertising and, unfortunately, it just does not convey the whole story and we can provide all the other aspects of that, so they understand the full story, such as the cost to own the plan, all premiums, all copays, everything they're going to understand.

Dave: Sure.

Jack: Yeah.

Dave: Jack, thanks again for being on It’s My Turn To Care: Secrets for the Dementia Caregiver for another week, I'm not going to double your pay, Jack. You're only going to get the standard rate, which is not very much, pretty close to zero, but we do appreciate you being on. If someone wants to reach out to you and get more information, how would they do that? [19:00.3]

Jack: They can visit our website, InsuranceSolutionsUSA.com. They can contact us through that or they can call our office directly at (817) 756-1442. Of course, they can text that number as well. But, Dave, we thank you for the opportunity to be with you today.

Dave: Great. Thank you, Jack. This is Dave Parks signing off on It’s My Turn To Care: Secrets for the Dementia Caregiver. We always encourage you to visit our website, which is HomeCareAssistanceFortWorth.com, and our office number is (817) 349-7599. We look forward to talking again with you next week.

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