Shownotes
We welcome Josh Kinzel, Benefit Advisor at Seniority Benefit Group. He is an expert when it comes to Medicare.
In this episode, we start to demystify Medicare, as we discuss its issues and confusions.
It is Open Enrollment (10/15-12/7) for Medicare recipients and needless to say, there are always questions!
Even if we are not old enough for Medicare, we may be assisting our older relatives to navigate the complexity of this program.
And actually, that is what Seniority Benefit Group, and other “connectors” provide – to start to demystify the process.
Let’s make sure we have the overall understanding of Medicare – and know the acronyms that come with it.
There are 3 basic areas that we need to remember – the basic “Medicare Plan” and what it covers, the “Supplement Plan” and what it covers, as well as the “Part D – Pharmacy Plan” and what it covers.
Depending on the individual’s needs and preferences, this could be 3 different parts of their health care or all one rolled into an Advantage plan.
Here's an example we consider. "I am turning 65 and know I need to be on Medicare. What should I do in preparation for my 65th Birthday?"
As someone turning 65, you need to understand your own medical history and needs in order to choose the best plan. How does an individual describe their health issues and physical abilities? And are there specific areas in each plan that an individual should pay very close attention to?
Part D which covers prescriptions has been a hot item for years. Any points that a new Medicare patient should beware of?
Assuming that even if an individual gets through their first year of Medicare with no problems, there may be issues that they wish they knew about before making decisions on health plans.
Josh shares what mistakes or problems he sees that individuals often undergo their first year, but could have avoided. He also offers us a list of things to watch for to avoid making obvious mistakes.
For those who are already on Medicare, are there changes to the law for next year that may make changes to Medicare plans that we should all be watching for?
Memorable Moments
00:00 Local resource in Dublin guiding through Medicare options.
05:56 Medicare terms can be overwhelming for people.
08:30 Effective conversation leads to personalized healthcare solutions.
12:53 Delay Medicare choices if covered by employer.
14:26 Medicare generally covers employer plan services as well.
18:47 Seek expert help navigating Medicare for simplicity.
20:23 Medicare drug plans have varying costs and structure.
25:04 Medicare users may face unexpected prescription costs.
27:26 Navigating Medicare choices, be mindful of restrictions.
30:16 Affordable Care Act reduces prescription drug costs.
34:42 Positive review: Great experience on this podcast.
Resources we mentioned we would include in our episode show notes.
Medicare Education and Outreach (Central Ohio Area Agency on Aging programs provided free to assist in educating individuals on Medicare)
Ohio Senior Health Insurance Information Program (OSHIIP) 1-800-686-1578
We would love to hear from you.
Give us your feedback, or suggest a topic, by leaving us a voice message.
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And of course, everything can be found on our website, Looking Forward Our Way.
Recorded in Studio C at 511 Studios. A production of Circle270Media Podcast Consultants.
Copyright 2024 Carol Ventresca and Brett Johnson
https://creativecommons.org/licenses/by-nd/4.0/
Transcripts
Because the other common misconception that I get from folks is that they they'll call me at 64 and a half and they'll say, Josh, well, I know I have to sign up for Medicare. I know I have to. I'm gonna be penalized for the rest of my life. I'm gonna miss this time. And I stop them there because as long as you have other coverage so as long as you're working somewhere, as long as your spouse is working somewhere where you're getting that coverage from their employer, you can delay these Medicare choices later Johnson a lot folks are doing that.
Brett Johnson [:Way are looking forward our way. We're in Studios c in the 5 11 Studios. This is Brett, and with me as always is Carol. How are you?
Carol Ventresca [:I'm good, Brett. How are
Brett Johnson [:you doing? Doing well. You know, today, we're gonna be welcoming Josh Kinzel from Seniority Benefit Group, and we'll be discussing the issues and confusions on Medicare. It's open enrollment for Medicare recipients, and needless to say, there are always questions. Josh, welcome to the show.
Josh Kinzel [:Thanks for having me, Brett. Hi, Carol.
Carol Ventresca [:It's good to see you again, Josh.
Josh Kinzel [:Good to see you too.
Carol Ventresca [:So, as Brett said, there's a lot of mystery around Medicare. And what we are really trying to do for our listeners is to give them information and help them figure out all of their options. So even if an individual listening to us today isn't old enough for Medicare, they may have an older relative who is up for Medicare and there are just more questions than any of us could ever imagine. So why don't we look at actually, what it is to navigate the system? And, with Seniority Benefit group and other connectors, how do you what do you provide to demystify this process? So give us a little bit about your organization.
Josh Kinzel [:Okay. Great. Thanks, Carol. And and I wanna just say demystify is such a great word. I'm gonna start using that because it is it is so appropriate because people do approach Medicare. They approach the age of 65, and and now all of a sudden, they've always known it's out there, but now they have to actually make some choices for it. Or like you alluded to, they have to make some choices for their parents where this is even they're 45, and they said, Way. I thought I had 20 years.
Josh Kinzel [:And so how we came to be was in 2,008, we realized that more and more of these employees we used to be in the employer benefit world and more and more employers were saying, okay, Josh, what does mister Smith do about turning 65? And so we were getting more and more of those calls. And so my my boss said, you know what? Let's just focus on this. We enjoy that aspect of it so much more than the employer benefit side of it, really. And so, selfishly, we just focused all our attention to Medicare in 2008. And we started saying, we're gonna start focusing on the mister Smith's turn of 65 because we realized there are a lot of things that it may seem simple to us who deal with it all the time. But when somebody is approaching this, it's it's that's not the case. Right. So our job is just to make sure that somebody, when they're approaching that age, feels comfortable about that and and not scared about it.
Josh Kinzel [:Take the because there are a lot of scare tactic tactics around that time, phone calls, mailers. And so we want to be a local resource. We're in Dublin. We want to be a brick and mortar place that people could show up. Now I know with COVID, it's a little different right now, but we're excited to be able to it's it's my boss always refers it to as a busy restaurant. People are coming in, getting help, and and where we're helping is just to say, okay, Looking, you are turning 65. All that means is that you have more options now, and so let's guide you through that Way, so you make sure when you do get to that point and you are on Medicare, that you're on the right path, that you've chosen the right plan, that that we have kind of looked at it for you, and we're holding your hand throughout that process. So we just try to take it from when you're 64 and really starting to get nervous about it, maybe bring a little bit of comfort into the equation.
Josh Kinzel [:We never charge anything for what we do. We feel that this the information is out there, so it's not proprietary necessarily. We just try to package it in a way that's understandable and really help guide you into your to your Medicare choices.
Carol Ventresca [:Right. And and those listeners who are not 65, don't be surprised that somebody doesn't ask you for help. I can remember only being in my forties when Part D came out and trying to help people. And there was no place to go for information to try to describe to understand and describe the donut hole.
Josh Kinzel [:Well, in It's Yes.
Brett Johnson [:Yes. Impossible.
Josh Kinzel [:That is a that's a topic that has been ingrained in our our speech, because it is specifically, and I know we're gonna talk about it later on, but that drug component of it is really where people have a lot of fear, I think.
Carol Ventresca [:Right. And
Josh Kinzel [:that's where we can not necessarily say everything is gonna be rosy, and and be honest about it, but but I think a lot of people appreciate the fact that we say, Looking. This is how the the system is set up. There is still a donut hole that is improving. The coverage gap is improving. Mhmm. But, yeah, there are just a lot of things that people hear and most of it negative until you start talking about it. And then it's and then it's not as scary as what they came into it.
Carol Ventresca [:And and that's that's the issue. The more information you have, the less scared.
Josh Kinzel [:Yes. You
Carol Ventresca [:can you can make informed decisions. Mhmm. So that's what we're gonna do today.
Josh Kinzel [:Okay. Great. Great.
Brett Johnson [:Let's make sure we have the overall understanding of Medicare and know the acronyms that come with it. From what I gather are 3 basic areas that we need to remember. 1, basic Medicare plan and what it covers, 2, supplement plan and what it covers, as well as 3, Part d, pharmacy plan and what it covers. Depending on the individual's needs and preferences, this could be 3 different parts of their health care or all rolled into 1 into an advantage plan. Let's talk a bit more about that. That's already confusing right there.
Josh Kinzel [:Yeah. Yeah.
Brett Johnson [:That's where the So let's kinda break it apart a little bit.
Josh Kinzel [:Yeah. Sure. And and that again is when we start to talk to somebody, that's what makes them scared is that there's so many terms out there. But when we start to say, Looking, Medicare Supplement is the same as Medigap that you've seen or when you talk to a neighbor that says, oh, I have plan f. You gotta go with plan f. They're all kinda saying the same thing. Right. So when we start to try to break it down into its fundamental senses, you're right, Brett, where it's original Medicare, that's part a and that's part b, And that is through the government.
Josh Kinzel [:That's not through private insurance companies. That's just through the government. A is your hospitalization. B is anything outside of the hospital. But neither of those include prescription coverage. So if you showed up with your Medicare a and b, which some folks say, hey. Look. I'm on Medicare now.
Josh Kinzel [:I have Medicare, and they show up at a pharmacy. That's not gonna cover their prescription piece of it. Exactly. So other things had to come out of that. And insurance companies took the opportunity to say, okay. We know Medicare a and b doesn't cover everything. So as an insurance company, we'll come in here and help cover those things. And so that's where we say we know we have to have Medicare a and b.
Josh Kinzel [:That's the building blocks of everything else. You have to have your hospitalization. You have to have your outpatient coverage, but that's gonna cover about 80%. So then it leaves you with the 20% that is open ended. There's no maximum out of pocket to that, and it also has no coverage when you go to the pharmacy. So that's where Brett, like you were alluding to, there's those two fundamental pathways to go down. And I think that kind of brings a little bit of peace to or comfort to folks to say, okay. But I have 50 mailers.
Josh Kinzel [:Well, you're telling me that there's only really 2 basic Way. And, yes, there are 2 basic pathways. Yeah. You either go with a supplement to cover that other 20% and a part d as in drug, drug plan, or you go with Way Medicare Advantage to your point, Brett, that lumps everything together. So that your choices, you're just trying to manage your out of pocket. How much risk you wanna take on? But we know we have to have Medicare a hospitalization. We know we have to have part b, which is your outpatient prescription or outpatient services. And then you decide how much more coverage you want and which of those two pathways are gonna be best.
Carol Ventresca [:And there are there are ways to figure which pathway is better. There are questions you need to ask yourself. So even though it sounds like this huge decision
Josh Kinzel [:Mhmm.
Carol Ventresca [:And yeah, you're stuck with it for a year Mhmm. But it there really is a way to to manage your way through it.
Josh Kinzel [:Well and I think what people realize is when we have more of a conversation, just start talking through things that that solution comes up where we're saying and we're saying, well, how often do you see a doctor? Or or do you have a chronic condition? Or how many medications are you taking right now? Or do you travel? Some of these qualifiers where when people start to answer questions a certain way, we say, well, in our expert opinion, then you're you're down this pathway of a supplement, a drug plan just makes some more sense or or it doesn't maybe you don't need that level of coverage necessarily based on Way you're telling me your your needs and wants are. So that is it it it when you just start talking through it, and I and I think what frustrates some people is after we go through the conversation, they say, well, what would you do? And and I always I always tell people, I'm not trying to dodge the question, but everybody's unique in this. So and and I just caution people to to don't assume that what your neighbor has is what's gonna work for you. So make sure you have your own personal discussion, whether that's with a a local person like myself or just some of the other resources that are out there because they are plentiful.
Brett Johnson [:And it sounds just like retirement Looking. Yes. Quite frankly. Sure. Because it's the same things you mentioned. Don't do what your neighbor says if they're doing because their their retirement goals are more than likely totally different than what you're gonna do. They're gonna go vacation every day of their retirement and you're planning on just sticking around here Mhmm. And enjoying Columbus.
Carol Ventresca [:Mhmm. Right.
Brett Johnson [:That's a totally different retirement plan. Mhmm. And I and I to what you're talking about, setting up these questions that kind of lead you down that path to this is probably the choice you're looking at because of all the factors you're talking about. It's very similar to retirement plan. Sure.
Carol Ventresca [:And and our goal for the podcast is to discuss a topic, but to make sure people have resources.
Josh Kinzel [:Right.
Carol Ventresca [:So my first question is, John Doe is gonna turn 60 5.
Josh Kinzel [:Mhmm.
Carol Ventresca [:The first thing that's going to happen is he's probably gonna get some materials in the mail. Mhmm. The the official Medicare materials.
Brett Johnson [:Mhmm. Mhmm.
Carol Ventresca [:And they gotta read it. It's long, but you gotta read it.
Josh Kinzel [:Right? Mhmm. Mhmm.
Carol Ventresca [:So so let's talk about what are the kinds of things people are gonna start seeing and how what should be their first steps?
Josh Kinzel [:Yes. Okay. So when you're approaching that age of 65, the one thing I tell people is your mailbox is gonna explode. And because every insurance company out there wants to tell you that they're the best thing since sliced bread. And but what I remind folks is the only real official mail that you don't wanna throw away is your Medicare card that will come to you if, but only if, you're drawing your Social Security benefit check at that time as you're turning 65. So if you've chosen to pull your Social Security check through your own working history or a spouse or someone else and you're approaching 65, Medicare will send you your Carol. So keep an eye out in that mail and that stack of mail for your Medicare card that will come about 6 or about 4 months, excuse me, prior to your 65th birthday. Other than that, though, if you're not your Social Security, 98% of this that's coming to your mail is a solicitation.
Josh Kinzel [:So just be aware that there are a lot of, the marketing budgets of these insurance companies are huge. They wanna make it seem like you need to read this. And, yes, you do. You do wanna become educated. But what we found is when we show up to someone's home where they bring in all the solicitation is that you can weed through it pretty quickly with with some of the right guidance. But as you're approaching 65, if you're pulling Social Security, make sure you look out for your Medicare card. But if you throw it away, you're not gonna be the only one that's done that.
Carol Ventresca [:Oh, no.
Brett Johnson [:So you offer recycling bin to the office. Exactly. All that stuff. Day. Yeah. Yes. Exactly.
Josh Kinzel [:Yes. Right. Mhmm. So but other than than that, really, when you're approaching it, you don't have to worry about what's coming in your mail because you can what you see on TV, you'll probably see it there, and then you'll also get a slip Forward in your your mail. Or you can reach out to to someone like us that we probably have it in our basement as well. But the main point that you it's not so much looking for something in your mail necessarily, but more so wrap your head around, do I need Medicare right at 65? Because the other common misconception that I get from folks is that they they'll call me at 64a half, and they'll say, Josh, well, I know I have to sign up for Medicare. I know I have to. I'm gonna be penalized for the rest of my life.
Josh Kinzel [:I'm gonna miss this time, and I stop them there because as long as you have other coverage so as long as you're working somewhere, as long as your spouse is working somewhere where you're getting that coverage from their employer, you can delay these Medicare choices later on. And a lot of folks are doing that beyond the age of 65. That's not your traditional retirement age anymore. And so what I when people say, well, what should I try to do? It's I try to tell them, start preparing for deciding whether or not you're going to necessarily need Medicare at 65, or are you gonna work beyond that, or is your spouse gonna work beyond that, because you can delay it. So what I always want people to know is just to make sure and look specifically at their situation. So check with your employer, check with your HR department. If you are a retiree and collecting your your insurance through a retiree type of situation, those are gonna going to be times where you have to enroll in Medicare, and so we have to do that in a timely fashion. But sometimes there are that is that possibility to delay it.
Josh Kinzel [:So don't think that just because you're approaching 65, you have to get on Medicare, but it is a discussion that you wanna have. And and that's the reminders that we give folks is that go back to whoever administering your plan and check that's those specifics.
Brett Johnson [:Yeah. So if someone turns 65, they need to understand their own medical history and needs in order to choose the best plan for them as we kind of alluded to earlier. How does an individual just describe their health issues and physical abilities? Are there specific areas in each plan that an individual should pay very close attention to as well?
Josh Kinzel [:Well, the one statement I'll make there is sometimes people's they're concerned with when they get to Medicare that some things aren't gonna be covered that they've been used to having covered Okay. Through their employer individual plan. And for the most part though, again, general statement is if it's being covered right now by an individual policy or an employer policy that you have currently, more than likely Medicare will cover it as well in some fashion. And then it just goes back to whether or not we're on that supplement or whether or not we're on a Medicare Advantage. How much of those bills you'll have to pay for those services? But the actual bottom line is that a lot of the employer plans go to Medicare first to see what they cover and and back it into their plans. But when we're talking about conditions and and physical abilities, there are some regulations actually from from our industry people know if they are someone that utilizes the plan a little bit more, that you need to see some doctors. When we say the the main qualifiers that we have initially are Way doctors do you see normally? What hospitals do you wanna have in a network? What medications? And so if somebody sends us a a very long list, we kinda know and we can back into it that Way, asking if there are some chronic conditions that they have that they have to maintenance through medications or or trips. But I I the the key that we wanna spend, when we're talking about those conditions, though, when we're looking at different options for folks, we just have to make sure that of those specialists and of those facilities that you may have to have those services done.
Josh Kinzel [:We wanna make sure that your plan, the bigger portion of it, and the bigger thing is is make sure that those providers are in the network.
Brett Johnson [:So be very, very honest about your needs then Yes. In that in that planning stage. Well
Carol Ventresca [:and and too, and when you're looking at providers, one of the situations that I heard about, was that, the the new Medicare, recipient had a nurse practitioner.
Brett Johnson [:Mhmm.
Josh Kinzel [:And
Carol Ventresca [:so there were a lot of questions as to whether that nurse practitioner would be, considered in those different, categories or in those different plans, so that really made the decision on which plan to take. Mhmm. So but, yeah, you you you really have to be you have to be truthful with yourself and truthful with whoever is helping you through this process, and you're not asking people questions because you wanna know the nitty gritty. I mean, really, who wants to know the nitty gritty? But it it it it does make a difference.
Josh Kinzel [:In the guidance. Yes. So it it's the more that you're you're willing to divulge to someone like us, it's just helpful in the recommendation. Right. Doesn't mean you have to take it, because, obviously, it's up to you. But the more that the more information you can provide about your lifestyle, about some of the things that are going on, it's just helpful. It's it it just makes it easier.
Brett Johnson [:And it could be something to the point that you're here in Ohio 6 months a year, and you're in Florida for 6 months. Yeah.
Carol Ventresca [:Right?
Brett Johnson [:Yeah. If you don't have transferable insurance, which most are, but if you look at a a local plan that really only covers local systems, that's not gonna do you any good in Florida. So even just that that comment makes a big difference on what you can choose.
Carol Ventresca [:And and here in Ohio, I'm thinking too, we're pretty lucky with to have some really large systems that even go out into rural areas. But I am guessing that in a lot of rural areas, you have to be really careful because, you know, the the the doctor isn't in your backdoor. Hospital isn't in your backdoor like it is in Columbus.
Josh Kinzel [:Yep. And, again, that all leads to that decision of which when we get to that fork in the road of a supplement versus Medicare Advantage, all of those things that we're talking about help guide down where if you're in a rural area, for instance, that's where maybe a supplement does come in handy because now you're not beholden to any network other than Medicare. So, yes, all of this factors in.
Carol Ventresca [:And bottom line, as as I, you know, be truthful with yourself because this is going to impact your ability to pay for whatever is not covered. And there are things that, you know, are gonna come up at some point in time, types of medication that may not be covered, whatever it is. So Mhmm. The better you do, the more research you do, the better it's gonna be in the long run.
Josh Kinzel [:Mhmm. And and that's where I tell folks that Brett us be the ones that do that research for you. You certainly could look through the Medicare and You handbook, which is a fantastic resource too, but it's information overload for a lot of folks. Right. And so if you find somebody that's this is what they do day in and day Our, may it's not as if you can't figure this out. It's not as if they couldn't go through the process. All the information's out there. But one of the keys to it is just if you can find somebody that you trust, obviously, and if this is all they do and they're not charging any extra for it, utilize the resources that are there.
Josh Kinzel [:Because another thing that we are very fortunate in in the Columbus area at least and and, across United States is there are there are resources out there for folks. We just have to find them.
Carol Ventresca [:Right. Right. When the one thing that I think, having that material in front of you and taking a look does help with the language and the acronyms. Mhmm. So when you're working with your resource, you make sure you're on the same page.
Josh Kinzel [:Well and I can definitely tell and and no judgment in the statement, but I can definitely tell if someone has tried to do this on their own as far as being able to at least know the lingo a little bit versus someone that said, I wasn't even gonna deal with this. I'm gonna let you start from scratch.
Brett Johnson [:Yes. Tell me that again.
Josh Kinzel [:Yes. Uh-huh. Right.
Carol Ventresca [:So, yeah, we just talked about it. Part d, pharmacy plans. It's critical. It is just critical. I don't think people realize how expensive medication has gotten over the past few years.
Josh Kinzel [:Mhmm.
Carol Ventresca [:So tell us a little bit about what we should watch for.
Josh Kinzel [:Mhmm. And and the main thing with prescription drugs that I like to tell folks is it's gonna be a little different than what you're used to when it when you had it through an employer plan or an individual policy where you could get used to the consistency of even though maybe it was a high dollar every month at the pharmacy. When you get into Medicare, it can turn into a little bit of a roller coaster. And how that happens is there's a basic structure on these drug plans, and there's 4 basic steps to it where there could be a deductible, where you have to pay everything up until you hit that deductible, so everything's out of your pocket there. Then once you hit your deductible, you pay a co pay, so a different price that you had just paid maybe the month before. Then there's this the coverage gap, the stone hole that arises once you've spent so much in a year where now you pay a percentage. And then beyond that, it's it's for folks who have very expensive medications. You get into a catastrophic situation where it's another cost.
Josh Kinzel [:So what we attempt to do, let people know upfront is that it's gonna be a little bit of a roller coaster. You could have the same medication that you fill in at the same pharmacy all year long and pay 4 different 4 different prices for it.
Carol Ventresca [:Right.
Josh Kinzel [:So what we found to be helpful is and there there are ways to do this is just when you have that list of medications that you're punching in, that it will tell you what they estimate for the year to cost. So he tried to put that aside Looking that some months are gonna be a little lower, some months are gonna be a little higher, trying to get people because I think what people get tripped up with to information is definitely power with this. And even though you may not want to hear that in June, your medications are gonna skyrocket a little bit, but they'll come back down. At least you're prepared for it. So part of our job really is to make sure we haven't created these plans, but we wanna make sure we explain them so you understand them and you're aware of what's gonna come up. So the biggest difference with these prescription plans is it's a little bit of that roller coaster.
Carol Ventresca [:Right.
Josh Kinzel [:The other the other aspect to them that people don't realize and which is fair, is that the pharmacy that you fill them is really going to make some difference sometimes where a CVS could be different than a Kroger, A Giant Eagle could be different than a Walgreens. And people don't go that extra step of saying, well, yeah, I'm used to CVS. But if all I have to do is transfer it over to Walgreens and I can save a little bit, why not do that? So really wanna make sure people are aware of the overall cost for the year. And then that pharmacy shopping is something that you wanna be able to do.
Carol Ventresca [:Well and it's just like really making sure that your doctors are covered under the plan that you're picking Mhmm. That if your if your pharmacy is not covered
Brett Johnson [:Mhmm.
Carol Ventresca [:Can you get covered? Yeah. Because in again, in some places, there may be a CVS and no Walgreens. Mhmm. So what do you do? The other thing too on prescriptions, I've noticed that happened recently. A lot of times, we weren't able to get 30 days of of a prescription unless you did it by mail. Mhmm. And so we were used to going every month. Then all of a sudden, you go to the pharmacy without anybody warning you, and you've got 3 months, which is great.
Carol Ventresca [:You don't have to go every month, but now
Josh Kinzel [:It's a 3 times charge.
Carol Ventresca [:The cost is 3 times.
Josh Kinzel [:Mhmm. Yeah. Mhmm. Mhmm. So and sometimes, it's just it it it's it's what we don't know yet when we go into it is that people are a little hesitant to use it for the first time because they just but I will say for our for our longer tenured clients that we've we've touched base with every fall, it is something you get used to. Not that we we we don't wanna get used to the high cost of medications, but at least we have the security of knowing that, yeah, it might be a 90 day charge. It might be higher in June July. But at the end of the day, those medications that we need are going to be covered.
Josh Kinzel [:We just have to be aware of how much they cost. Sure.
Carol Ventresca [:I I have a question that's sort of off topic here a little bit.
Brett Johnson [:Mhmm.
Carol Ventresca [:You see on the commercials where you've got those little Go Rx cards or GoodRx cards or whatever it is. Are those legitimate?
Josh Kinzel [:They are legitimate. Yes.
Carol Ventresca [:And that's helpful.
Josh Kinzel [:And it can be helpful. Yes. So just another aspect to this is you can use your prescription plan, but you can also use these these coupons that are out there. And there are a lot of them. GoodRx being one of them that seems to work well. I use that for my family. We're not on Medicare, but we use it because and it's one of those things that people say, well, how does this work? I don't necessarily know, but I know it does work. And I know you can use it with with your, prescription drug plan through Medicare.
Josh Kinzel [:The other warning, for lack of a better term, is when people get to the Medicare world and the prescription specifically is sometimes they don't realize how much their medications really truly cost. Exactly. And when a lot of people are accessing these more expensive medications through manufacturer discounts. So when we're starting to talk to somebody and and we say that a certain medication is gonna cost, maybe $1500 this year, And they go, oh, no. I have a Carol, a discount card that's only $5 a month. One of the worst parts of my job is I have to tell them those discount cards Forward whatever reason no longer work when you're on Medicare. So another thing to be kind of preparing yourself for is some of those brand name medications that you're taking. Maybe start having those conversations with your doctor to see if there are any generic alternatives.
Josh Kinzel [:Sometimes there's not. But if there is, that's that's something that we would recommend. But then and I and I hope this changes. They always talk about changing this. But at the this moment in time, you could have at 64 and and 11 months, not on Medicare. You could have a manufacturer discount for your $500 medication where you're only paying $5 for it, co pay Carol. As soon as you roll over into a prescription drug plan, that goes away. And so that's just something that, again, trying to tell people upfront.
Josh Kinzel [:It's not news we'd like to deliver, but at least it's something that you have to be aware of.
Carol Ventresca [:And and it could be a really good reason why you decide to delay Medicare, if you can.
Josh Kinzel [:Yes. Mhmm. Alright.
Carol Ventresca [:Interesting. Interesting.
Brett Johnson [:So I'm assuming that even if an individual gets through their 1st year of Medicare, no problems. There may be issues that they wish they knew about before making decisions on health plans. Can you share what you see as mistakes or problems that individuals often undergo during that 1st year? Could it be avoided and and maybe a list of things to watch out for to avoid making obvious mistakes.
Josh Kinzel [:Sure. Sure. I think one of the most common misconceptions is when people view this open enrollment time with that, we're we're it's upon us where you can make changes to your plan between October 15th December 7th. Sometimes people make the assumption that you can change any plan you want to any other plan you want without any medical questions. Because when you first are eligible for Medicare, go to any insurance company you Way. You can go to any type of plan you Way. And, again, no medical questions. So people assume that they always have that freedom to move about the cabin.
Josh Kinzel [:And so I keep going back to you have those 2 basic Way. And so when I do warn folks and it is that if we go one pathway, we may not be able to go to the other without those medical questions, even if we do it within an open enrollment time. So sometimes people will be attracted to, let's say, Medicare Advantage, for instance, to go back a little bit, where these are the plans that you see on TV that you don't pay any extra premium for. And people say, well, that sounds great. And then maybe because I don't go to the doctor very often right now, and I'll just wait for an open enrollment. And then when I maybe need to go to the doctor more often, I'll just jump over to one of those Medicare supplements that I hear about to cover everything. And, yeah, I'll pay the premium and but at that point in time, those insurance companies are allowed to ask you medical questions, which they weren't at the beginning. And so that's that's the biggest thing and really just don't fall prey to something that that looks great on TV, where you really have to keep going back to the network piece of this is because that's where I I feel bad for someone who come to us maybe after making the decision on their own and saying, hey.
Josh Kinzel [:Look. This plan is awful. And and I said, well, did did you take the extra step of at least finding making sure that all your doctors and hospitals are in? They go, well, no. But the the person that called me on the phone made this sound like it was the greatest thing. So the the the network piece of it, just make sure you look at those before we go with 1 of the Medicare Advantage. They they can work very well, but be aware of the networks and be aware that there can be some medical questions later down the line.
Carol Ventresca [:That that's a big one. Mhmm. And I I do remember, hearing from individuals telling us to be careful because of that. Mhmm. That you can't you can you can go Medicare to Advantage, but you can't always go Advantage back to Medicare.
Josh Kinzel [:Yes. Yeah. Yeah.
Carol Ventresca [:Which is huge.
Josh Kinzel [:Yeah. Okay. Mhmm. Mhmm.
Carol Ventresca [:And given that we're not really sure what's going on in Congress right now Uh-huh. Can do we have any indication that there's any changes that are gonna be made for 2021 or do
Josh Kinzel [:we know? The the one change that is beneficial that we know of that is going to be implemented for some of these insurance plans is help for people on insulins. And so insulins are one of those medications that that can be very, very costly. And and it's something that obviously people aren't choosing to be on insulin, but it's they need it to survive and and for quality of life. And what on some of these plans, they are capping what you have to spend for insulin at $35 a month. Wow. And it's and it's also not going toward your Medicare, donut hole that you're worried about too. So when you're if you're on one of these plans that have the $35 insulins, you don't have to pay it towards your deductible. You don't have to pay it into your your coverage gap.
Josh Kinzel [:So that is the one very good thing that that we've seen. The other thing that has been happening since the affordable care act has been implemented is that donut hole again to bring that up is how it became known as a donut hole or coverage gap is when prescription drug plans came out and you were in that gap, you paid a 100% for your medications. There was no coverage. It was if you were in a hole. And with the Affordable Care Act, which was great, is that they were shrinking that. And so now, when someone's in that that coverage gap, you pay 25% of your medication. So again, not free, certainly, but you're not paying a 100% any longer, and that will continue to be to be there as well going forward. But other than that, no major shake ups.
Josh Kinzel [:Every year, Medicare does come out with a new, premium of what you pay for the the part b piece of it. That but that hopefully won't change much. We're not hearing that that's gonna change much. Deductibles for Medicare changed slightly. But the big thing that we are excited about, because we have a lot of folks who take insulins. That's just the reality of life, and so we're we're really looking forward to being able to to transition maybe to a plan that helps that a little bit. Okay. Wonderful.
Josh Kinzel [:Yeah.
Brett Johnson [:Well, this has been a great overview of Medicare. Mhmm. I I I much highly expected this is what was gonna be this episode. I was glad because we knew we got to the right person. I knew we were going to do that. So, any last words of wisdom?
Josh Kinzel [:Way I don't be shy to ask for help. I know that's the you probably hear this across all industries, but really, there are folks out there like us, that are local. If you're more of a face to face type of person, you don't wanna be called on the phone. Obviously, COVID's a little bit different now. We're all struggling with it a little bit, but in normal times, we're somewhere you can go in. You don't have to be worried about being steered one way or another. Just really just ask for help. Don't don't be stressed about making this decision.
Josh Kinzel [:I always tell folks that it is. It's just another way of picking your insurance. I know that that makes it very simplistic, But maybe just trying to make it not seem so monumental of a choice that yeah. Maybe we can't make all the changes at any time that we want, but we're not making the decision necessarily for the rest of our lives. So just just make sure you use the resources that are out there.
Brett Johnson [:You know, I didn't ask, and it just came to mind too, is that, okay, you do know that you're gonna retire at a certain age. Mhmm. Let's say it's not the 60 five, it could be 66, 67, whatever. Mhmm. Is there a, like a mark in time when you decide, okay, I'm gonna retire in November of my 60 7th year. Should they get a hold of you or someone like you, like, maybe 6 months prior to that or a year? I can't is there a time period that's wise?
Josh Kinzel [:Yep. Yep. And there's always people on both ends of the spectrum there where somebody will call me and say, well, I'm planning on retiring in 5 years. What do I need to do now? Which is fine, and and that's more how I operate anyway so I can relate. But but on the other side of the coin, just this morning, someone called and said, I'm retiring at the end of this month. I lose my benefits October 1st. What do I need to do about Medicare? And they're still gonna be okay. At the end of the day, again, it's it's a little bit more frantic than what I would choose personally, but at the end of the day, that individual I talked to this morning will have coverage on October 1st, and they'll be okay.
Brett Johnson [:And they may not have known because our HR person didn't tell them until well, oh, by the way, you don't have and it's like, oh, really? Okay.
Josh Kinzel [:Yeah. So But a sweet spot, I would Way, that 6 months is really kind of a good because then you have the conversation without out that deadline staring us in the face necessarily. So you can have an initial conversation to kinda wrap your head around the basics of things. And knowing that as it gets closer, maybe the 3 months out, maybe the 2 months out, we actually start turning the paperwork with you. Mhmm. But so 6 months really is a good amount of time.
Brett Johnson [:Good. Wonderful. Good. Good.
Carol Ventresca [:Well, Josh, we wanna make sure that folks know how to get a hold of you Mhmm. And seniority benefit group Mhmm. And, also general information about Medicare. So for our listeners, all of this information will be listed in the show notes.
Josh Kinzel [:So Okay. Great.
Carol Ventresca [:Check on that. And, if you have questions from for Josh from this episode, then you can contact him
Josh Kinzel [:Right.
Carol Ventresca [:Through that information. But in the meantime, thank you so much. It was wonderful to see you again. Yes. Thanks. And to to get an opportunity to, touch base and to also give this great information to our listeners. We appreciate it.
Josh Kinzel [:Well, I I'm happy to do it, and and I'll just throw a plug out to anybody else that may be listening if Brett and Carol call you to be on this podcast. They are fantastic to work with. I came in here very, very nervous. This is my first podcast. I'm walking away feeling like I'm an expert. Now they they just they really just they make you feel great. So if if anybody's on the fence and they call you to come and talk about what you're an expert in, take the call, come on in, and and this is just a great service. So I'm happy to be here.
Carol Ventresca [:Thank you. Wonderful.
Brett Johnson [:Thank you. And the and the limo's ready for you. Yeah. Okay.
Josh Kinzel [:Thank you.
