How to Plan for Health Costs by Aligning Client Needs with Coverage
Episode 7925th August 2022 • Human-centric Investing Podcast • Hartford Funds
00:00:00 00:23:43

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More than 90% of seniors have Medicare coverage that they’re paying too much for and that doesn’t match their coverage needs. Healthpilot CEO David Francis dives into how financial professionals can help their clients re-evaluate healthcare costs and provide easy solutions to potentially save them thousands of dollars.

David Francis is not affiliated with Hartford Funds


John Diehl [:

member or for many financial professionals, I'm sure with a client? About Medicare, supplemental

insurance, all that kind of stuff where you just feel like, I'm not sure that was a good conversation.

Julie Genjac [:

sounds like alphabet soup to me, frankly. I haven't done my research and oftentimes I find myself

nodding in agreement, and I'm not really even sure what I'm agreeing to. So I don't feel as if I'm

giving good guidance. But honestly, I have no idea where to go to gather that guidance.

John Diehl [:

podcast episode that we did with Dave Francis from Health Pilot about how to plan for health care

costs, aligning needs with coverage. And so, hey, let's go listen to what Dave has to say about

how we might have better conversations around this topic. Hi, I'm John.

Julie Genjac [:

John Diehl [00:01:08] We're the hosts of the Hartford Funds Human Centric Investing Podcast.

Julie Genjac [:

best ideas for how you can transform your relationships with your clients.

John Diehl [:

Dave has been at the forefront of leveraging information technology in the health care market with

a passion for improving the customer experience in health care and a strong belief that

transformation of individual wellness and market efficiency can be gained only by focusing on

each individual customer within the context of the larger market. Dave co-founded Health Pilot to

be a deep, trusted partner of every health care consumer. Prior to co-founding Health Pilot Dave

was Chief Operating Officer and chief financial officer at E-health, where he led the company's

turnaround and growth from:

more than ten times during his tenure. Prior to eHealth, Dave was an industry leading investment

banker and research analyst, focused on the health care information technology industry, leading

Wall Street firms, including the Royal Bank of Canada and Jefferies and Company. Dave is well

known for his strategic vision in the health care and technology markets and is a frequent speaker

and guest lecturer on finance, health care and technology innovation. They've earned a B.S. in

economics from the Wharton School of the University of Pennsylvania. Dave, welcome to our


Dave Francis [:

John Diehl [00:02:48] So Dave, I think with all of the recent talk about inflation, I think most people

are aware that health care inflation has historically run ahead of core inflation by quite a large

margin. But I think because inflation is on everyone's mind, everyone's looking at health and

health care costs and thinking about how is it possible to minimize health care costs in in in

retirement. And I, I think when I as a as a financial professional myself, when I think of health care

costs, sometimes I kind of default to, oh, Medicare, I'll take care of everything. Can you start us

there and maybe describe for us a little bit about why that probably represents a problem in our

industry these days?

Dave Francis [:

on. The health care costs for seniors in particular is is a really consequential issue for folks. And if

you if you think about seniors as they enter retirement and they live their lives through retirement,

oftentimes they're asking their financial advisor two questions as they reach the stage in their

lives. One is, do I have enough? Do I have enough money to retire the way that I want to? And

then the second is, you know, can you help me with this Medicare thing? Because I'm no longer

on my employee, my employer's health insurance? And I, I know that the government has health

insurance for me, but I keep getting these messages that there's there's a lot that I need to be

considering around that. And the health care problem for folks these days is is something that is

that is big and only getting bigger. And inflation generally is is further compounding that issue. So

when you think about Medicare, Medicare insurance from the government covers a lot of of a

person's health and health care costs, but that really doesn't solve the entire cost problem for

them. Medicare generally covers when you think about hospital visits and things like that, only

covers about 80% of a person's health care expenses. And on top of that, the drug side isn't

really covered by original Medicare and premiums within Medicare. People think that they've paid

into Medicare, so they just get it for free at the end of the day. They actually have premiums taken

out of their Social Security account and those premiums, particularly on what's called the part B

side of Medicare. I've been going up considerably over the last several years. So inflation

generally is causing a problem for folks relative to having a fixed income and limited financial

resources. Health care costs are going up. The way that insurance is taken care of relative to

Medicare and what have you is is not a is not a silver bullet for them. So there's a lot to be

concerned about. To be thinking about is as people are reaching retirement age. And for those

folks that are in retirement, health care costs are always going to be an issue. And figuring out a

way to manage those most effectively is something that we do here at Health Pilot.

Julie Genjac [:

financial professionals, myself included, studied some of these concepts maybe for an insurance

license maybe a few decades ago. And, you know, if you're not entrenched in these

conversations every single day, this hasn't become really the core or the niche of one's financial

advisory practice. I believe that things change so quickly and the rules, the policies, the programs,

it's just hard to wrap one's arms around. I know that just yesterday, in fact, I was having this

conversation with my mom. My parents are 64 and she's been helping my grandmother, who is in

failing health, sort of adjust her Medicare plan. And and my mom is trying to figure out how to all

of the pieces work together. Right. How does their primary medical work with with Medicare and

all the different parts? What are they paying for? You know, how can all of the pieces talk to each

other? And she actually had to laugh, but I thought it made kind of some sense in the moment.

My family's never met a spreadsheet they didn't love. And so she actually created a spreadsheet

of all of the different Medicare programs and plans, and she has been querying all of her friends.

What do they subscribe to? How much do they pay? What ailments do they have and why did

they choose it? I thought it was actually a very creative way to sort of get to the bottom of this. I

don't think she's come to any conclusions. Like I said, I was very proud of it and I'm excited to

review her findings. But if you think about sort of the interconnectedness of all of that, my guess

is that many financial professionals are in the same situation. Right. You know, asking clients

about some of these high level health issues, looking at current plans, can you talk us through,

you know, what some resources may be to help sort of that integration of all of this so that at the

end of the day, our financial professionals feel as if they guided their clients in a way that makes

sense and clients can lay their head down at night saying, I've got the coverage that I need. I feel

comfortable with it. And maybe most importantly, I'm not overpaying for resources that don't even

apply to my situation right now or even in the future now.

Dave Francis [:

see that spreadsheet at some point in time because I'm sure that it's good. It's a work of art and

it's it it's the kind of thing where it's so hard to wrap your head around all of the different things

that that you need to consider on an individualized basis as it relates to to health insurance,

particularly for seniors in a in a medicare environment, you know, every every single individual.

Well, let me take a step back. You know, financial advisory professionals have you you've got a lot

on your plate. So there's there's so much that you need to be thinking about as it relates to all of

your clients and particularly those that are that are approaching. And then in retirement age,

relative to to making sure that the asset base is there, that it's protected correctly and that it's

there, it's going to last your your client throughout their their retirement time so that they can live

their best life in retirement. That's that's what everybody is is aiming to do. When you think about

everything that's involved in the the health care decision making process, it is it is an entirely

different and complex set of of questions and regulations and and inputs and outputs that that it

just it doesn't make sense. And it's it's virtually impossible for someone in your seat to be able to

master both the financial side of things and the health care side of things. On top of that, there's

all kinds of licensing requirements and regulatory requirements. It really is virtually impossible for

for anybody in your shoes to to be able to master both of those, which means that that more

often than not, a financial advisor when when asked the question by a retiree or a soon to be

retiree, hey, can you help me with this Medicare insurance thing? More often than not, and we've

done some some recent studies, I'll share some data with you more often than not that that

professional is referring your your client out to somebody else. I know a guy. And as a result,

hopefully you've got a trusted relationship with somebody in the Medicare insurance space that

you can take your client to. But you lose you lose track of what's going on with with your with

your client, a person with whom you've been working for for years, if not decades, to build this

this financial plan and nest egg for. And you just you have no idea what's happening to them

when they when they go outside of your network or your ecosystem to solve for this Medicare

insurance thing. And a lot of things that that need to be to that need to be accounted for there,

particularly what is the what is the premium that my my client is paying for health insurance? Are

they properly insured in the first place? What's their expected out-of-pocket cost every year for

health care? And how does that relate back to the financial plan that I've been I've been building

for for this client for years? All of that goes dark. And you just you're you're kind of rolling on a

wing and a prayer and some some rough estimates relative to, well, I think this is what it's going

to do to impact the what the Medicare insurance is going to do to impact my my client's financial

plan. But you really just don't know. The other piece that you're that you struggle with is is as you

say, what what what are the resources that either I as a financial advisor or that I can pass on to

my client to use to figure out this whole this whole Medicare thing. There really aren't any good,

trusted sources of easy to digest, easy to access, easy to understand, information that let people

figure out, okay, in my circumstances, given the doctors I see, the drugs that I take, my current

health status, my current economic status, what's what's best for me from a health insurance

perspective, I usually relied on IBM or Coca-Cola or Comcast or whoever my employer was to

guide me in the right direction for for this is this is the plan or these are the sets of plans to to pick

choose one in the Medicare market. It's it is unbelievable the number of of options and and

different types of products, different types of plans. What's covered, what's not covered? What

are my co-pays, the permutations of of different different financial impacts? Are these things are

there exponential in terms of the complexity? And back to your point of where do you go to get

help for this? There are a few resources out there. A lot of people visit, the

government website for for for all things Medicare. There's a lot of information there. But you're

you've got to rely on your own smarts to kind of figure it out. And then back to your point, the

really diligent folks will build their own spreadsheet and still not feel terribly confident or

comfortable that they're making a really good decision. It seems as though this is something that

somebody ought to be able to build a technology platform around to help people out for. And

amazingly, nobody had ever done it until now. And that's what we set about to do in Health Pilot.

And so when you look for a resource, whether you're a financial advisor or a or an individual

customer, we believe that we've built everything there to to help you figure out what's best for you

and then use the technology to find exactly the best the best plan for for your health and

economic circumstances today.

John Diehl [:

following you, I think we're going to have Julie's mom on. And so to walk us through the

spreadsheet and see how that goes. But, you know, when you when you were just talking through

some of the some of those points, I think I heard, but I want to ask you more directly about what

are some of the major levers, right. Some of the very high level levers that a financial professional

might want to be listening for in a conversation with the client, either about current health

condition or status, or even changes as the client ages. Like, you know, obviously one that comes

to mind are the types of pharmaceuticals that they're taking the drugs drug platform, because,

you know, there are a lot of people out there that don't even understand. Do I need to do

Medicare Part D? Is that my only option? What are the options if I don't do that? What's the

difference between self insuring and finding outside insurance that covers that? So I would think

that those formularies are one, but are there a couple of high level levers that financial

professionals are at least be listening for?

Dave Francis [:

little bit of a word, Sal, out there. Medicare Part A, medicare Part B, Medicare Part D, Medicare

Part C, co-pays, deductibles, premiums, total out-of-pocket annual out-of-pocket drug premiums,

donut holes, you name it. There's there's just a few of the multitude of of buzzwords and and and

alphabet soup kind of things that that one runs into when when they start to look at Medicare.

And that's why as we look at financial advisors and everything that you all have to do to to serve

your clients, trying to figure all of that out is, is a virtual impossibility and asking you as a financial

advisor to engage with your customer to to help them with all of that stuff on the health care side

is it's just it's an impossible task. And candidly, it's an impossible task even for Medicare experts.

I will tell you, when I help my folks through this process, it's it's just it's very difficult even knowing

as much as I know about the marketplace to to explain to them in an easy to understand terms,

hey, this is why this plan is better than this plan or this product is better than this product for you.

And here's why. And that's why, quite, quite frankly, we built Health Pilot, which was to take the

burden of Medicare insurance completely off the shoulders of you, the financial advisor, on behalf

of your client and for your client themselves, and be able to solve this problem for the rest of their

lives and be able to it to help people that don't understand that there's there are different parts of

Medicare insurance. What's the difference between Medicare Advantage and Medicare

supplement? What is a Part D drug plan and how does that fit into the the whole process? It's it's

just it's too much for any any individual person to really understand and then keep track of all the

changes in the marketplace. When you think about a single individual and we always talk about a

mrs. Smith, Mrs. Smith is is kind of our poster child. She she is the the the person who needs

help figuring out what is best for her. And there are there are 65 million. Mrs. Smith's in the

marketplace today, each of whom is different in terms of their specific needs from a health and

economic perspective today relative to what they need from a health insurance perspective. And

those needs will change over time. So, you know, you touched on a few of the things, but the the

big picture things that are really important to an individual client of yours is who's my doctor? Do I

like my doctor? And can I find a plan that that fits for me that has my doctor in-network? You can

actually find a plan that lets you keep your doctor as an example. What drugs do I take? Are they

are they fully covered? And if I if I take different drugs over time, is is somebody helping me

monitor that so that I can make sure that the insurance I have today is the right insurance that I

need down the road? When I when I first retire, I might be looking to do some traveling and I have

some, some extra discretionary income that I'll be going out to do some additional things with. I

might have a vacation home. So I've got I've got a home in in Michigan and a home in Florida. Is

there a how does my health insurance plan fit into. And what kind of products and considerations,

considerations should there be around that? There's an awful lot that goes into that that is just

very difficult for for an individual broker on the Medicare side and certainly for a financial advisor

to keep track of and be able to to to manage, particularly knowing that the the the increase in the

number of health plans, the different companies and insurance companies that have been coming

into this marketplace over the last several years has just been growing and growing and growing

because of the economic opportunities for those folks. Just as a quick example, the number of

Medicare Advantage plans, you hear a lot about Medicare Advantage and about four in ten

seniors are covered by Medicare Advantage plan today. The number of those plans in the last

seven years has doubled from:

and the complexity and figuring out and tracking what's covered in each of those and what's best

for me as a customer. It's it's impossible to do without the help of technology and and something

like what we have built here at Health Pilot that focuses on the individual needs of each of those

one or each of those specific customers and clients of yours to figure out what is the best product

for them and help them enroll in that in a way that's very easy, confidence, inspiring, and lets

them live comfortably knowing that, hey, I'm in the right health insurance product. I know that I

can get the health care I need. I know it's not going to bankrupt me and I don't have to worry

about it anymore so I can go out there and live my retirement life the best way possible, which is

what you've been doing to try and help them from a financial perspective. The whole way we

come alongside the financial advisor as a as a technology partner to allow you to help your

customer live, live and take care of this very consequential decision for them today and for the

rest of their lives.

Julie Genjac [:

spreadsheet obsolete, would you give us a brief overview of if I'm a financial professional logging

on to your technology platform, what information might I need or what does that process look like

for me to input some data for a client who's asking about Where do I go? What path should I

head down?

John Diehl [:

Dave Francis [00:20:23] For for a financial advisor. It's it's simple. We have made the entire

process, both for financial for the financial advisor and for the your client. The customer drop

dead simple. So for a for a financial advisor, we equip we equip you with a with a portal and also

an entry point, either through Money Guide or through Redtail or through Wealth Box. Any of the

CRM that you might use an easy touchpoint to essentially refer your client into our platform.

Typically, through an email, you simply click on Mrs. Smith's information and send her an email

that we've already pre-populated for you that that essentially says, Mrs. Smith, I'm introducing


you to the to the folks at Health Pilot and they're their easy to use platform to help you find and

enroll in the best Medicare insurance plan for you. It'll take you about 15 minutes, but you'll be

able to to have confidence that when you're done with the process that you are, you're enrolled in

the best health insurance plan for you. Given your health and economic circumstances, your

doctors and drugs and everything will be taken care of for you on the back end of that process.

Once you've referred Mrs. Smith into the health pilot platform and she ultimately enrolls in the

product, we close the loop with you, the financial advisor, so that that through that, that data

integration, we're able to tell you Mrs. Smith is enrolled in this specific health insurance product.

Her expected out-of-pocket costs this year will be $6,422. You can work that confidently into your

financial plan. And now, instead of guessing as to to a, is she properly covered and B, what is it

going to cost her to to have health insurance this year? You now have a rock solid basis around

which to take care of that piece of the financial plan and know that the rest of the financial plan is

is protected from an insurance perspective on the health care side and and something that you

can rely on going forward relative to to her financial position on a go forward basis.

John Diehl [:

kind of educate us a little bit about some of these topics. It sounds like it's an area where there is

gross inefficiency and and that's probably a good area for us to look, especially when it comes

time for cost savings or more than anything, improving the customer experience. So for those of

you listening today who would like to find out more about Dave and the health pilot company, you

can visit Health Island dot com slash advisor to begin your journey in making health care easy,

efficient and effective. Your senior client certainly gives you another alternative to consider when it

comes to having health care costs conversations with your clients. So, Dave, thanks again for

joining us.

Dave Francis [:

Julie Genjac [00:23:14] Thanks for listening to The Hartford Funds Human Centric Investing

Podcast. If you'd like to tune in for more episodes, don't forget to subscribe wherever you get

your podcasts and follow us on LinkedIn, Twitter or YouTube.

John Diehl [:

client relationships, email us. A guest booking at Hartford Funds dot com. We'd love to hear from


Julie Genjac [:

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