Medicare Part A, B, and D
Announcer: Welcome to our fireside chat with Seniors Living Healthy, the podcast that helps prepare and educate you as you enter and live out your golden years. With over 10 years of experience, Nick and Zach are experts in the senior market and are here to help you live a healthy, full life. And now fireside with your hosts, Nick Keene, and Zach Haire.
Zach: Hello, and welcome back to episode six of season one of Seniors Living Healthy. I’m joined here as always with Nick.
Nick: Hello, folks.
Zach: So, this episode, we’re going to wrap up what we’ve covered the first five episodes this season, touch base over what we have talked about, do a little refresher, review course. And then we’re going to look into what next season is going to bring, and that’s where our guest, Ty Wooldridge, President of Aetna Senior Supplements, will come in. We interview him, kind of looking forward to financial security once you do retire. So, as we just jump in here, we’re going to talk about the parts of Medicare and the different things out there that can fill in those gaps in Medicare. Nick’s going to run through those for us.
I’ll ask him some questions, he’ll just review them real quick to make sure everybody’s up to speed if you’re just now joining us, you’ll know we’ve touched on the last five episodes. So, Nick, as you know, we’ve been discussing the parts of Medicare this past season.
Zach: So, real quick, let’s start out with Part A of Medicare, give the listeners a run-through on that.
Nick: Yeah, so I want to start out real quick with the Part A and Part B, Zach, about who qualifies, when they qualify, and when they get it. So, individuals that have worked 40 quarters or 10 years and paid into Medicare, [unintelligible 00:01:45] payroll taxes mainly, qualify for Medicare, including any dependents and or spouses of those individuals. And other individuals, whether it be through disability, in limited circumstances regardless of age, or end-stage renal disease, or ALS can qualify as well, Zach. So, back to Part A, your question. Part A is hospitalization.
Anytime an individual is admitted to the hospital, they are covered under Part A and a couple things to remember under Part A is there is a period of care: that is 60 days, and that is covered with a $14058 deductible in the year 2021. So, beyond that, there are additional day costs, day 61 through 90 in the period of care $371, and then 91 through 150, they’re responsible for approximately $742 per day. The other thing that we’re seeing more in this market as it regards to Part A, Zach, is skilled facility care. I know you and I talk with clients about this quite frequently. But skilled facility care comes in a lot when people have to go to rehabilitation facilities, whether it’s following a stroke or some sort of debilitative condition.
And if they are in the hospital for three or more days, and released, and admitted to a skilled facility within 30 days, Medicare will pay day 1 through 20, and then they’re responsible for day 21 through 100 at approximately $185 per day. And that pretty much rounds out Part A, Zach.
Zach: Great. So, real quick on Part A, circling back there talking about the days in the hospital, the window of care, we know it’s a 60-day window of care. Kind of, explain how that resets, how that works.
Nick: So, a period of care ends when an individual goes 60 days without care in the hospital or surrounding arena. So, not to be confused with the first 60 days period of care that’s covered under the Part A deductible, but also beyond that going 60 days without additional care.
Zach: Great, perfect. So, rolling in there. Next part is our Part B of Medicare, which is a lot more in play than Part A does.
Nick: Absolutely. So, Part A is paid in typically via payroll contributions, 10 years or 40 quarters, and there is no premium. With Part B there is a standard premium and in the year 2021, that premium is $148.50 per month. There is something called IRMAA, Zach, that can allow people to either pay less for their premium or more, depending on their income.
Your Part B is elective. So, whereas Part A is automatic, there are plenty of individuals that are still working when they turn 65. They may have insurance through their retirement, through their union; that’s considered credible coverage, so it’s certainly elective. Reach out to us, reach out to someone to answer your questions about what may work or what may not work in that regard. But if someone does elect to take Part B, they can expect to pay a premium typically. And Medicare Part B has an 80/20 coinsurance: Medicare pays 80% of all outpatient claims, and the insured is responsible for the remaining 20% after a $203 outpatient deductible.
Zach: So, a little trivia question for you, Nick. We get asked this all the time: Part A or Part B; which one pays for the shingles shot?
Nick: Shingles. That’s a good question. Shingles is covered under the Part D. Your flu shot is the common shot covered under Part B.
Zach: All right. There you go. So, leading into that, like Nick just said, your Part D of Medicare. That’s probably our number one complaint—
Nick: [laugh]. Yeah. Absolutely.
Zach: —that we get because our hands are pretty tied on that. Kind of want to touch base on those there, Nick?
Nick: Yeah, so one of the biggest challenges that we run into Part D, Zach, is they’re regulated. You can only make changes, typically October 15th through December 7th outside of your open enrollment or new to Medicare phase. And with effective dates taking effect 1/1. And outside of limited instances, people are locked into those plans, January 1st through December 31st. And people’s medications have a way of changing.
A lot of times we get individuals that we run a drug plan, it seems like a perfect fit. Things arise, health conditions arise, new medications come into the picture, and we get phone calls, “Oh, this medication costs $100 a month,” or whatever that is, the important thing to remember folks is prescription drug plans all have to meet a minimum benefit that Medicare determines, okay? And what that means is they have to cover at least two drugs in every therapeutic class. However, some drug plans may cover different drugs in those therapeutic classes. So it’s important that you reach out to a professional, reach out to us, let us look into the options.
Let us get a list of your scripts, your dosages, the frequencies you’re taking them, let us make sure that we get you with a preferred pharmacy that’s going to offer you the lowest cost for your drugs. All of those things are important when it comes to picking a drug plan. And keep in mind, Zach, just to circle back, with Part D and Part B, if a Medicare-eligible enrollee doesn’t have credible outpatient or Part B coverage or Part D drug coverage, they can be penalized by Medicare.
Zach: Yeah, they’ll get their part, cut one way or the other, that’s for sure. So, one more thing I want to touch on Part D of Medicare, we get questions all the time, the dreaded doughnut hole. Do you want to touch on that real quick?
Nick: Just to build up to the doughnut hole real quick, Zach. There’s four phases in a drug plan: the deductible, the initial phase, the doughnut hole, and the catastrophic phase. And one of the things to keep in mind is, it’s dollar amount thresholds that move from one portion or phase of the drug plan into another. So, when an individual and the insurance company reach a combined out of pocket total of approximately $4100, they enter into the doughnut hole, in 2021. And once they enter into that doughnut hole, then it’s an approximate combined total of $10,000 that has to be spent between the insured, the insurance company, and the drug manufacturer before they get out of that gap.
So it’s an approximate $6,000 gap that individuals can be responsible for a high portion of cost of certain drugs. So, we get a lot of complaints: “I had flat copays on my drugs. All of a sudden, I hit the doughnut hole, and now I’m paying 40-some percent,” or whatever it may be of that prescription. One thing to know, folks, is all drug plans are built with a doughnut hole. The only difference being is some plans offer additional coverage within the doughnut hole. But of course, that’s at an additional cost.
Zach: Definitely. So, as we’ve seen there, there are some gaps in especially your A and B of Medicare. We do work mainly here a lot of times in ways to fill in those gaps. And we’ve touched on those as well. And the two different ones. The first one is the Medicare Advantage Plan. And, Nick, discuss how that doesn’t really fill in the gaps. What is an Advantage Plan on the surface before we dig into it?
Nick: Yeah, and one of the things to keep in mind about these products is as we go through the Medicare Supplements and the Medicare Advantages: there’s pros and cons to both products, and one product doesn’t fit everybody’s needs. That’s where a professional needs to ask you the right questions. How often are you using your healthcare? How often are you going to the doctor? Do you have any pre-existing conditions, et cetera?
But one of the things that Medicare Advantage Plans do, Zach, and I think is what you’re alluding to, is they actually replace an individual’s Part A and Part B of Medicare. So, it can create some network limitations. Medicare is nationwide: California, North Carolina, Michigan to Florida, whereas those MAPDs—or Medicare Advantage Plans—have networks associated with them.
Zach: Since it does replace the A and B, they have to be similar where you to go in the hospital. I know, like I said, plans vary a little bit. You’re on a Medicare Advantage Plan; you go in the hospital. What kind of expenses should you be looking at to incur?
Nick: Yeah, so on original Medicare, you have that $14058 deductible that covers your initial period of care. So, Medicare Advantage Plans do something similar—and keep in mind, they’re all different, so I’m just going to talk in broad terms—but typically your Medicare Advantage Plans are going to have per-day cost when you go into the hospital, whether that’s a day one through three, day one through five, day one through six, there’s going to be something similar or equivalent to the Part A deductible of original Medicare.
Zach: Great. So you’re talking about the networks and everything there. There are a couple of different types of plans out there, I know when it comes to HMO and PPO; those are the two biggest ones we see. Kind of give a quick run-through, if you don’t mind, the difference in the two of them.
Nick: Sure. So HMOs, in our business, we know is the gatekeeper policy. Everybody that takes their state license test, regardless of where you take it, you get the gatekeeper question. What that is, is an HMO is a type of policy that is designed to be administered solely through the primary care physician. Any healthcare an individual gets, they have to go through the primary care.
And to see a specialist or go out of network, they have to get a referral. That’s the gatekeeper giving that pass, that referral. Whereas an HMO is a little different, Zach. And by the way, the HMOs are smaller, typically, in-network; they’re for individuals, certainly, that don’t travel much, as they don’t have much out-of-network coverage short of emergency care. PPO—Preferred Provider Organization—policies don’t require a referral.
And what that means is an individual can get care in-network or out-of-network, albeit at a higher cost, so it gives them a little less restriction, and moving about, and traveling, and not having to be near their primary care physician.
Zach: Gotcha there. There looking at Advantage Plans, just from what we know about them, a lot of times they are zero premium. There are ones out there that have premiums. But I think you’d agree, Nick, a lot of times with an Advantage Plan, you’re looking at paying less than the front end where you might possibly with copays and deductibles on the back end see a bill.
Nick: Oh, absolutely. I mean, there’s—look, there’s no perfect way to go about this. You either pay on the back-end when you use it or you pay upfront, and kind of go from there, right?
Zach: Yep, so next, moving in with that is the Medicare Supplement. And in the name itself, it supplements Medicare. So, looking at it there, Nick, give a rundown of Supplements, what someone should be looking for, in there in the Supplement market?
Nick: Absolutely. So, I think you said it all up front, Zach. It supplements Medicare. What does that mean? Medicare remains the insured or the client’s primary, which gives them access to doctors, facilities nationwide.
And the good thing to know about a Medicare Supplement, whereas a Medicare Advantage Plan replaces Medicare, a Medicare Supplement falls in behind Medicare. Medicare still pays primary, Medicare is accepted almost nationwide, anywhere we go. Rarely ever do we run into a doctor or facility that doesn’t accept Medicare. And the good thing to know about the Medicare Supplements is regardless of what company or plan you go with, as long as the facility, the hospital takes Medicare, they’ll accept any company’s Medicare Supplement policy. So, with that, Zach, I mean, there’s a number of different plans.
I’m not going to go into all of the different ones, but it’s one of those things where once again, we need to be asking the health utilization questions. How often are people going to the doctor? Do they have any pre-existing conditions? Are they looking for a plan that pays everything regardless of the cost, or are they more motivated by savings opportunities, maybe being willing to take on a small deductible or take on a small copay each time they go to the doctor? So there’s multiple common plans, and not one is best for everybody. That’s where our questions come in. That’s where we come in.
Zach: Yep. So I’m looking there, putting the two together. If I’m getting ready to go onto Medicare and looking at the two or say I’ve been on Medicare for a few years, made some changes, how does my health play into this?
Nick: Yeah. So, with Medicare Advantage Plans, there are no health questions. Basically, if you reside or live in the plan service area, and you have Part A and B, you qualify for any Medicare Advantage Plan at any age. Medicare Supplements are a little different. Outside of select periods, being the open enrollment period and guaranteed issue periods where an individual would lose credible coverage through no fault of their own, all of your supplement companies—in most states; the standardized states at least—are going to have health questions.
Now, some companies are going to be harder to qualify; for some companies, not so much. But the good thing about health questions, especially for healthy people is the more nos you can give me, the cheaper your price goes. So, health plays a big part in the Medicare Supplement market, and that’s why it’s so important, Zach, for individuals that are new to Medicare to think about this up front because if they have some of those chronic conditions that we see all the time in our market, it’s a get out of jail free card, they qualify for anybody. So, if you’re new to Medicare, about to be turning 65, or about to take on Part B of Medicare, you’re in a select window that is your time to shine. Reach out, give us a call, talk with us, let us ask some questions, and let us make sure that we set you on the best track forward moving into Medicare eligibility.
Zach: That’s another big thing, too we haven’t touched on yet are Supplement Plans. There’s a lot of plans out there using Plan G, for example, plans themselves are standardized.
Zach: So, real quick here at Senior Benefit, if you touch on what we do, if you’re already on a Supplement with those plans being standardized, what we can do for you.
Nick: Absolutely. And later on in this podcast, I’m looking so forward to speaking with Ty Wooldridge at Aetna Senior Supplements; this is what they do. But as a broker here, not only do we work with Aetna, not only do we work with all of these A-rated providers, when it comes to Supplements, they all offer the same products. They just have different qualifications, maybe different prices, some companies may offer a household discount, others may not. So, our job is to find the individual the plan that best fits their needs and then the lowest price. So, working with all of these major providers, not only do we have the opportunity to give folks impartial advice about what plan is best for them, then we also have the ability to give them that plan at the best price out there.
Zach: Yep, definitely. Last one here on that note, we get asked this a lot: can you have a Supplement and an Advantage Plan?
Nick: Technically no, Zach. When you have a Medicare Advantage Plan, you replace your Medicare. So you’re on a Medicare Advantage Plan, not quote-unquote, “Parts A and B of Medicare.” That fundamentally runs against everything a Medicare Supplement is. To supplement Medicare, you have to be on Medicare.
So, by definition, you can technically have a Medicare Supplement and Medicare Advantage, but the Supplement’s not going to pay anything. Because Medicare’s not paying primarily, therefore the Supplement won’t pay secondarily.
Zach: Yep. Thanks, Nick, for kind of running through everything we’ve covered there the last five episodes. Hope it caught you guys up or maybe cleared some things up, answered more questions for you. So, now we look forward to jumping on a phone call here with Ty Wooldridge.
Zach: All right guys, and welcome back. So, for our next segment here, is our interview section. So we’re going to have Ty Wooldridge from Aetna Senior Supplement jump on the line here with this. He’s actually the president of the Senior Supplement side of Aetna. Ty, how are you doing today?
Ty: I’m doing well. And I certainly appreciate you guys having me on today. And absolutely glad to do it.
Nick: Thanks, Ty, we appreciate you joining us.
Zach: Glad to have you on. We know you’ve been working this market for a very, very long time, so as we look forward to our next season on the podcast, where we’re going to be looking at people getting ready to retire and make sure they have that financial security once they get to that point in life. And we just wanted to run some questions by you, let you help some people out in that area. And I know you just joined that market here recently yourself. [laugh].
Ty: Yeah, that’s right. Yeah, I recently turned 60. So, a lot of what I’ll talk to you about is really based on my own experiences. I’m going through this in real-time.
Zach: Yeah, perfect, perfect. So, first up their Ty, if you don’t mind, share with us the importance of financial planning moving into retirement?
Ty: Well, sure. And honestly, even before you get to be my age, really, the importance of financial planning starts as early as possible. And you guys probably remember, my background was in actuarial science, and I can tell you that the time value of money is an important ally when you’re retiring. If you just took $50 a week, and you invest in that, even at a really low rate, like 4% which, as an average rate for 40 years, which is fairly low, you have a quarter-million dollars by the time you’re 40 years out. So, really the most important thing is you absolutely want to start; it is never too early to start.
But as you near retirement, what you have to understand is, you move away from putting money away and taking care of that, you switch into an era where your money is now going to take care of you. It’s going to switch direction. And as you near that retirement, it’s important to ask yourself a lot of questions; get some help. You really have to plan this; you have to think about how much money do you need? How healthy are you?
Because that can matter some of the decisions you have to make. What restrictions are there on how or when you can access the money that you’ve set aside? Are you planning to continue to work? How long do you think you will live? How much other income do you plan to have? Those are things you absolutely have to think about.
But even more important than that, when you get into this area, kind of, where I’m in here, you start thinking about all this money changing directions and taking care of you, got to think about the impact of taxation. And that’s where you really need to do some planning. How you move money from wherever you’ve got it stashed to the distribution phase of your life can matter a great deal on how much you’re going to lose in taxes. It can depend on the instrument that you used to have saved the money, or how much you took out, or when you take it out, whether or not you’re married, your tax bracket. All those things come in, and it really is best to even get a little help with that. And I know you guys are big into that area and you certainly have my thanks. I mean, you do some great work helping people with this because it is very, very difficult.
Zach: That’s probably the biggest thing we get here is like you stated, people being worried they’re going to outlive whatever they put up—
Nick: —in today’s world, today’s time, people living a lot longer than they used to. And we answer that question, or talk to that question about people, almost on a daily basis here.
Zach: Wrapping up your answer to that question, some of the things that we get asked most frequently are individuals with savings accounts, 401k, they’re about to start taking on Social Security. When should they take Social Security, et cetera? Tell us how those things can impact someone looking at retirement.
Ty: I would say the biggest thing you have to think about is whether or not you want to be your own investment manager or you want somebody to help you with it. If you decide that you’re going to be your own investment manager, regardless where the money is, you’re going to need to be prepared to invest your money and assume the full risk of that return. You can go out on your own, you can purchase an annuity that’s going to provide some guaranteed returns or you can invest it in the stock market or other things, but the key is, you’re going to be deciding for yourself what you want to do, and you’re taking on the risk that it’s going to last long enough. Now, if you want to seek the help of a professional, you absolutely want to choose wisely. And I don’t know if you guys are familiar with the show American Greed, but nobody wants to be on that show.
Ty: And you have to remember, if it sounds too good to be true, it probably is. It took you a long time in life to save whatever you manage to save; you want to make sure that you’re very careful and thoughtful in thinking about, well, how do I want it to pay out. And you do have to think about not just yourself, but if you’re married, you have to think about that. There is—unfortunately, it’s pretty likely that one of you will proceed the other one in death, and you want to be thinking about taking care of that other person. There may be a lot of other things to think about.
But absolutely, when thinking about this, whether you decide you want to do it yourself, or you want to get the help of a professional like you guys, you absolutely want to think that through because you can you can actually—there are a lot of instruments out there, as you guys know, that will pay you in installments and they’ll take the risk on that you’ll live too long. Now, they’re not going to pay you perhaps as much as if you managed it yourself, but those are the things you have to think through.
Zach: Perfect there, Ty. So, building off what Nick said there as well, social security is one of the options out there. What are some benefits to taking so security at 65, or delaying it until a little bit longer down the road?
Ty: Well, the first thing you got to remember is your actual retirement date might not even be 65. Mine is actually 67 because of when I was born. But the decision of when you want to take your Social Security benefits can be a complicated one. I mean you’re actually playing for how much you’re going to get per month. I mean, if you retire before your full retirement age, then you’re going to get less per month than you otherwise would get, and there’s a discount.
You can retire as early as 62, but that may mean you might end up receiving as little as 70% of the full benefit that you’ve earned, depending on your birth. Now, on the other hand, if you wait until after your full retirement age, you’re going to get a little bit more. It adds generally something like 8% per year, I think, is about as much. But again, it’s a fairly complicated formula, and it depends a great deal on the year you were born. But the thing is, you’ve got to think about well how long am I going to live and how much am I going to need to spend?
There may be some very good reasons for taking it early. If your health isn’t good, and you believe that perhaps you won’t live to be 100, it may make more sense to take a smaller number now, then wait, or if you’re not really particularly reliant on Social Security, and you’ve already retired by the age of, say, 62 or something, it may make sense for you to go ahead and accept it. But the other thing you got to remember is you’re also playing with taxes. If you retire early, but you’re still working, your benefits are likely to be reduced or offset. And social security benefits can also be taxed depending on the amount of income that you’re earning.
So, it may not help you very much to do this early. Of course, as I said, your health and your life expectancy: big factor in the decision. But another thing you got to remember, if you are married, and you’re thinking about a surviving spouse, or if you have a disabled child or something along those lines, retiring early, that smaller benefit impacts them, too. And the calculations following your death, they will be impacted, they will be, in all likelihood, subjected to a smaller amount than otherwise had you not waited and retired on schedule. But here’s the one thing that I would say to anyone: be sure to have the Social Security Administration office that you’re dealing with compute your benefit every way possible before you make a decision like that.
It can be fairly complicated. And in many cases, depending on your life and what’s happening with you, there’s more than one way to compute the benefit, and some of them may be decidedly larger than others. So don’t be afraid to get some help with that. And if you don’t really want to deal with people directly, you’ll find that the ssa.gov website is actually pretty helpful in helping you make those decisions.
Zach: Perfect. Thanks, Ty. That’s a lot of help, I’m sure, to a lot of our listeners out there because that can be a big burden on their mind, coming up on retirement.
Nick: We get that question with people becoming new to Medicare daily, I would say. Rolling into the next topic here, Ty. We know Aetna’s always up to some good things. Tell us the different ways that Aetna’s looking at working with this market to secure their financial future?
Ty: Right. As you guys know, we have traditionally been in health insurance. That’s been what we’ve done. We’ve worked with, you know, Medicare Supplement is the business that I run for Aetna, and I’ve been very successful there, but over the years, we’ve discovered that seniors have a lot of needs that sometimes insurance can fill. And over the years we’ve added things like cancer coverage, we’ve added life insurance protection, we’ve added dental insurance, a lot of things like that because they’re needs that seniors have.
And in that line of thinking, you know, we continue; we always have something in the workshop, something in our research and development area that we’re looking at. For example, later this year, we’re going to be rolling out a new life insurance product that will have a substantial discount if you already have Med Sup with it. We think it’s going to be very exciting for folks. We’re also going to roll out a new product, a new dental product that is more comprehensive than the one that we have in the market today. And we’ve been playing around with some other things that, maybe, people would be less accustomed to seeing come out of someplace like Aetna.
And those are the kinds of things that we’re tinkering inside. And we’ll see if we ever really trot those out. But among them are things like companion insurance, which is really a form of pet insurance designed for seniors. And we’ve even talked a lot internally about the possibility of offering a multi-year guaranteed annuity for folks because making your money last is extremely important to seniors. More to come on that, but those are things that we’re working on behind the scenes.
Nick: Very cool. And one thing that I want to point out to the listeners out there, if you’re a Med Sup client of ours, whether with Aena or another company, reach out to us in the near future. This is an opportunity not only to get some great rates with a great company on your Medicare Supplement but also an opportunity to get some great rates on a final expense policy as well.
Ty: Absolutely, guys. And listen, hey, I really appreciate you guys having me on. This has been a lot of fun. I always enjoy talking to you guys.
Nick: Very much.
Zach: Hey, no problem. Thanks for joining us, Ty. Just in closing here, I know you touched on a few things. Anything else about Aetna here you want to let the listeners know anything about it?
Ty: Well, honestly, I guess I’d want to say thanks. I’ve just celebrated my 10th year working with Aetna in this Medicare Supplement, and we’ve grown from an organization that had… I think we had 140,000 members. 140,000 policyholders back when I came on 10 years ago. Today, we’re approaching one and a half million.
Nick: That’s awesome.
Ty: The growth has been tremendous. Certainly, you guys had an awful lot to do with that. I appreciate that. But I know your listeners, many of them are going to be policyholders, and we really appreciate the trust that you guys put in us. We work hard at this.
It’s a great business, we love it, we wouldn’t want to be doing anything else. And certainly, we want to do all we can in the coming years to add other things that people need. And of course, our relationship with CVS is also very important to us. We’ll be looking to try to leverage that in coming here as well. So, a lot of work to do. Certainly not ready to retire just yet.
Nick: [laugh]. Just want to follow that up. We appreciate your time, and I want to let our listeners know we support Aetna, we think it’s a great company. And now you know why. There’s why straight from the top. Ty, we appreciate your time. You have a blessed day, sir.
Zach: Thanks for joining us, Ty.
Ty: You bet. You guys, too. Absolutely. Thanks, guys.
Zach: No problem.
Zach: Again, we want to thank Ty Wooldridge for taking time out of his busy schedule to join us and answer some tough questions about retirement and find that financial security, once you do retire; start looking into retirement. We hope you’ve enjoyed this episode as well as this past season. Our goal is to answer the questions we get on a daily basis and help you take on retirement like a pro, whenever that time comes for you.
seniorslivinghealthy.com, or our company website is getspi.com, either one. We’d love to hear from you guys. Call us, email us, fill out the information on our website. If you have any questions, concerns, that’s what we’re here for to help you guys out, answer your questions. We want to make sure that you have the best plan coverage out there for you to meet your needs as well as your budget. Like I said, we’re always out here for you. And so here’s to another prosperous and successful year, and good day and God bless.
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