00;00;01;14 - 00;00;21;21 Cary Hall And now America's Healthcare Advocate, Cary Hall. Hello, America. Welcome to America's Healthcare Advocate show. Broadcasting coast to coast across the U.S., our producer, Mr. Darren Willhite. I'm your host, Cary Hall. This is your show, America. Thank you for joining us and making us one of the most listened to talk shows throughout the United States. You know, we've got over 200 affiliates around the country. 00;00;21;28 - 00;00;41;14 Cary Hall So, folks, listen to us on AM and ask him. But we now have 14 podcast platforms and YouTube, and it's growing every day. It's amazing to me how this thing has taken off. I think a couple broadcasts ago, I spoke to you about a group in Turkey that had downloaded one of our shows. When the gentleman who was the CEO of the company walked into their offices. 00;00;41;17 - 00;01;06;00 Cary Hall They had the podcast up on their computer screen. So it's great that people are listening to us, not just here in the United States, I guess, but all over the world. We think that's wonderful. There are 14 podcast platforms Spotify, SoundCloud, RSS, Overcast, Rumble, Apple Pocket Cast, Pandora, TuneIn, Stitcher, Spreaker, Amazon, Google Podcasts, Audacy Podcast, and also on YouTube. 00;01;06;00 - 00;01;27;09 Cary Hall So you can download the show there if you want to tell somebody about it. This is one you're probably going to want to do that, especially if you have somebody in your family who is chronologically challenged like me and you're interested in Medicare because this is our annual Medicare Open enrollment show in studio with me the good people from RPS Benefits by Design, Maria Ahlers and Carolee Steele. 00;01;27;09 - 00;01;30;09 Cary Hall Welcome back for the 50th time, I think is it. 00;01;30;12 - 00;01;31;26 Carolee Steele Like that we always love to hear. 00;01;31;26 - 00;01;49;27 Cary Hall Yeah, yeah you guys are old hands at this. So it's really, you know, how quickly it goes, So we're just going to dive right in because the whole purpose of this is to educate you on Medicaid. There's a lot of confusion around this. You see all these crazy commercials on television. There's you know, you get a lot of stuff in the mail. 00;01;50;03 - 00;02;08;07 Cary Hall I mean, it's amazing how we're bombarded with information on Medicare and how much of it is misinformation and something it's not going to do you any good or misrepresentation. And so that's why we do this show every year. So I'm going to start with Carolee and just Carolee. Let's just talk about when does open enrollment start? 00;02;08;10 - 00;02;17;25 Carolee Steele Open enrollment starts October 15th and it goes through December 7th. However, information can be obtained October 1st for the 2024 season. 00;02;17;27 - 00;02;33;03 Cary Hall That's a short window. You're you're not talking a lot of time here. You basically have got but two months if that little short of two months actually in to make this decision. And what happens is people just get complacent. 00;02;33;05 - 00;02;44;12 Carolee Steele They do. And each year it is so important to kind of review your Medicare health and drug coverage just to make sure it's still fits your needs, It fits your finances. And this is a time if you want to make a change. 00;02;44;19 - 00;03;01;16 Cary Hall I can't emphasize that enough because we're going I'm going to give you some specific examples of changes that have been made, some of them good, some of them not so good that you that you're going to want to know about. And the reason that Carolee says you need that review is to see if, hey, you know, what you've got is great, everything's fine. 00;03;01;16 - 00;03;17;18 Cary Hall They haven't changed the benefits or, Oh, by the way, do you know they've changed this particular benefit that's going to affect you dollars out of your pocket or access to care or prescription drugs or something else. So that's what we're going to do today. We're going to talk about that and we're going to bring that information to you so you can make a decision. 00;03;17;18 - 00;03;32;25 Cary Hall And by the way, if you're part of that sandwich generation, it's your mom, your dad, your grandmother, your grandfather that you're taking care of. Maybe you have power of attorney. Maybe you're the one that helps make these decisions. You might want to make sure that, you know, they download this if you want to have them listen to the podcast. 00;03;32;25 - 00;03;50;15 Cary Hall So they understand what's going on and might be a little easier to convince them. If you think they need to have review, maybe make a change. So let's just start with original Medicare to Medicare Advantage or original Medicare to Medicare supplement. Let's just talk about that because you hear this all the time. Well, I've got Medicare. I don't need to do anything else. 00;03;50;16 - 00;03;52;27 Carolee Steele Oh, yes, you do. 00;03;52;29 - 00;03;54;04 Cary Hall And why is that? 00;03;54;04 - 00;04;07;11 Carolee Steele A and B and B only covers about 80% of all services. So if you have $100,000 medical occurrence, you're kind of on the hook for that $20,000. And there is no out-of-pocket on that, which is really a scary thing. 00;04;07;13 - 00;04;27;08 Cary Hall Okay. So let me translate that out to a little better for you to really understand. She's saying there's no cap. So if it's 20% of 100,000 or if you had open heart surgery, it is 250,000, you get to pay 20% of that and believe me, the hospitals will pursue you to get that 20%. They're not going to write it off. 00;04;27;10 - 00;04;46;05 Cary Hall They've got a very robust collection policy in every one of these hospitals. I don't care where you are. If you're listening to me in Largo, Florida, one of our newest affiliates here out in San Bernardino, California, or you here in the Midwest somewhere, these hospitals pursue this very seriously. So so A and B, yes, they cover a lot, but. 00;04;46;05 - 00;05;07;16 Carolee Steele They cover a lot, but they cover A covers hospitalization, skilled nursing and hospice. B covers pretty much everything else, which would be your, you know, doctor's visits and your outpatient, you know, Durable Medical Equipment, echocardiograms. That's going to be your B service. And that's about 20% of, like you said, a heart surgery is quite a bit. 00;05;07;19 - 00;05;19;08 Cary Hall Yeah, it is. Or cancer or whatever the case may be. And so that therein lies the issue. So so now let's contrast that with OK, I went out and got a Medicare Advantage plan. Now what's my exposure. 00;05;19;10 - 00;05;32;01 Carolee Steele Now you're exposure. Well, and typically most of them are a zero premium and they have a maximum out of pocket. So you are exposed to only what that maximum out-of-pocket is for any A and B Medicare covered service. 00;05;32;08 - 00;05;43;18 Cary Hall Yeah. And you know what's interesting, Maria, is every carrier out there and Carolee just mentioned is I don't care if it's United, Humana, Blue Cross, Cigna, who am I leaving out... Aetna, they've all got zero premium plans now. 00;05;43;19 - 00;05;44;03 Maria Ahlers Yes, right. 00;05;44;03 - 00;06;05;22 Cary Hall They do. And people sometimes call. How can that be? I was just to get the question of what's the gimmick? What's the catch? There is no gimmick and there is no catch. There's zero premium because the carriers are getting reimbursed by Medicare (CMS) to manage your Part A and part B, And by the way, they do a lot better job of it 00;06;05;22 - 00;06;27;15 Cary Hall than Medicare does okay the level of fraud under see under Medicare Advantage plans is less than 1%. You don't even want to know what the number is under Medicare. Okay. It's ridiculous. The amount of money every year that is is misused, stolen and otherwise misappropriated because the good folks at Medicare are handling it themselves. That doesn't happen on the Medicare Advantage and Medicare supplement plans. 00;06;27;17 - 00;06;36;20 Cary Hall So let's just talk about, you know, what breakdown of Medicare Advantage plans, the different pieces of it and what it covers on the Part B in the party and all the rest of it Carol. 00;06;36;23 - 00;06;43;06 Carolee Steele Well, and the companies that do offer Medicare Advantage plans, they must follow rules set by Medicare to. 00;06;43;08 - 00;06;44;10 Cary Hall Go out and create a plan. 00;06;44;10 - 00;07;05;15 Carolee Steele Correct. They have to do that. However, what differs is the out-of-pocket maximum co-pays defer all of their little supplemental benefits of dental vision. Hearing may differ a little bit. You may pay $20 for a specialist at this carrier, 35 on this carrier. Those things differ, however, in general, they have to follow some Medicare rules. 00;07;05;15 - 00;07;26;09 Cary Hall So basically what we wind up happening and what we want to have happening is they have to follow certain Medicare rules. So there is an out-of-pocket max. So you can't wind up with more of a liability than whatever that dollar figure is. We can give some examples that in a minute. And then there are co-pays. So the Medicare Advantage plans have co-pays for almost everything you do except preventative. 00;07;26;09 - 00;07;31;14 Carolee Steele Right. Preventative, All preventative for mammograms. Your your lab services for the. 00;07;31;17 - 00;07;32;16 Cary Hall Colonoscopies? Colonoscopy, as 00;07;32;16 - 00;07;35;17 Carolee Steele long as it is preventative. It is covered. 00;07;35;20 - 00;07;49;14 Cary Hall I'm just saying. Okay, you can't use the excuse to got it. It's going to cost money because it's free. It doesn't cost you anything. Okay. Yeah. So so all of those preventative services are covered at a zero co-pay and there is no out-of-pocket for them, right? 00;07;49;14 - 00;07;49;27 Carolee Steele Correct. 00;07;50;02 - 00;08;00;22 Cary Hall Yeah. So, so when you contrast that on the other side, if you just have the A part and part B, we’re back to that 20% exposure , I don’t care what you 00;08;00;22 - 00;08;06;18 Carolee Steele get done. And the drug plan as well. So if you only have A and B you what are you going to do for the coverage for all of your medication? 00;08;06;21 - 00;08;13;06 Cary Hall And that's the part D prescription drug coverage and that's part of inside of the Medicare Advantage plan. 00;08;13;07 - 00;08;21;24 Carolee Steele A lot of Medicare Advantage plans do have a drug coverage benefit. So you don't pay an additional premium for a standalone Part D drug plan. 00;08;21;24 - 00;08;32;12 Cary Hall And there are plans that don't have the drug coverage in them. Most specifically, the plans that are for veterans. So Blue Cross and Blue Shield has one called the Valor plan. What does. 00;08;32;14 - 00;08;49;03 Carolee Steele Honor plans? And then I've heard of other ones too. And typically those have great coverage for some of their, you know, co-pays, co-insurance for their doctors, but they do not have meds in. So it's a supplemental benefit to the VA. It does not replace it. 00;08;49;08 - 00;09;12;01 Cary Hall No. But here's the good news. If you you know, if you want to go to a private physician and not go to the VA, all right. You've got access to anybody in that network. Okay. That's that's the real good news. Most of the reasons that we see for veterans not moving off VA is prescription drug coverage. What they've done is they've carved out prescription drug coverage, let the veterans keep their medications over at VA. 00;09;12;07 - 00;09;16;04 Cary Hall But you can get everything else just like anybody else on a Medicare Advantage plan. 00;09;16;05 - 00;09;23;18 Carolee Steele Some people want to be able to go see a primary care physician around the corner instead of having to go to the VA facility. And that's a zero cost to them. 00;09;23;19 - 00;09;26;19 Cary Hall Some people might not want to wait four months, five months. 00;09;26;22 - 00;09;27;27 Carolee Steele And they want a second opinion. 00;09;27;27 - 00;09;51;03 Cary Hall Yeah, as opposed to trying to get into the VA to get a surgery done or get a specific elective done, whatever the case may be. So there are options and alternatives. And the whole purpose in going through all of this with you and doing this today is you really do need to talk to somebody. You really do need to take the time to sit down with somebody that understands this stuff because there are a lot of changes and that's what we're going to talk about today. 00;09;51;11 - 00;10;09;10 Cary Hall So we'll be right back after the break. You're listening to America's Healthcare Advocate broadcasting here on the HIA Radio Network, Coast to Coast across the USA. If you want information, go to the website. RPS Benefits by Design Inc dot com. Stay tuned. We've got more right after the break. 00;10;09;13 - 00;10;42;18 Steve Kuker The golden rule treat others as you want to be treated. I'm Steve Kuker and this is one of the founding principles of my firm, Senior Care Consulting. Since 2002, our value statement has included honor, our mother and father, respect our elders, care for those in need, and treat your family as our own. We've been honored to help hundreds of families make one of the most difficult decisions they could ever make, serving them in their greatest time of need. 00;10;42;21 - 00;11;11;00 Steve Kuker If you're looking for someone who can provide you experienced and objective guidance when searching for a senior care community, reach out today and discover the services of Senior Care Consulting at 913 945 2800. Know your options and choose with care at senior Care consulting dot com. 00;11;11;02 - 00;11;32;13 Cary Hall Welcome back. You're listening to America's Healthcare Advocate show broadcasting coast to coast across the USA. My producer, the always perfect Mr. Darin Willhite. I'm your host, Cary Hall in studio with me, The good folks from RPS Benefits by Design, Maria Ahlers and Carolee Steele. And this is our annual open enrollment rollout of Medicare show here. We're talking all things Medicare, Medicare Advantage. 00;11;32;19 - 00;11;50;15 Cary Hall Again, you know, I reiterate that you really do need to talk to somebody, but look, you've been on a plan for two years, maybe you've been on it for three years. You think everything's great, maybe it is okay and then maybe it's not. And we're going to point out some things to you today. There are changes being made every year on these plans. 00;11;50;21 - 00;12;13;26 Cary Hall This year, there are some pretty significant changes out there. And if you don't know what to look for, you're not going to understand it until it hits your pocketbook or until it hits your ability to see a doctor or get something done that you want done. By the way, what does it cost to use somebody like the folks at RPS Benefits by Design who are CMS certified Medicare experts? 00;12;13;26 - 00;12;34;11 Cary Hall Zero. You don't pay them anything. There's no there's no cost to you. Okay. So there's no risk here. But there is a big reward as opposed to doing it the right way or doing it the wrong way, because wrong way can cost you a lot of money. It may cost you access. So that's one of the reasons why I'm urging you to take the time to reach out to these folks if you want to get a hold of them anywhere in the country. 00;12;34;11 - 00;12;54;06 Cary Hall 877 385 2224 and the website RPS Benefits by Design inc dot com There's a landing page up there fill it out they'll have somebody reach out to you to be happy to help you. Didn't you tell me a story off air about a lady from New York calling you? 00;12;54;10 - 00;13;12;05 Carolee Steele Well, she was actually a VA person, and so we kind of looked at that like the valor and the honor ones where they don't have prescription drugs. She was so enamored by the fact that she was going to have $1,000 worth of either dental, vision, hearing. She wanted all of it for transportation because she didn't have anybody to take her to the doctor. 00;13;12;05 - 00;13;22;03 Carolee Steele So she wanted that VA plan that's going to supplement her other VA. I mean, she wanted the plan to supplement her VA plan. It's not going to replace it, but she wanted the transportation. 00;13;22;04 - 00;13;38;28 Cary Hall So explain that, though. So so that's one of those things that's an additional benefit that the carriers bundle up. And this is really how they kind of compete with each other. They compete with each other on the out of pocket maxes and things like that. But where they really get in the weeds and compete with each other is on all these ancillary benefits that they add on. 00;13;39;03 - 00;13;50;16 Cary Hall So who's got the best deals? And we'll talk about some of those in a minute. But that particular thing that you're talking about is an add on benefit. And she had $1,000 worth of transportation. That's a lot of Ubers. 00;13;50;16 - 00;13;53;00 Carolee Steele She use it all for transportation, a lot of. 00;13;53;01 - 00;13;53;28 Cary Hall Ubers folks. 00;13;53;28 - 00;13;54;14 Carolee Steele Correct? 00;13;54;14 - 00;14;12;10 Cary Hall Yeah. And so that's a classic example of if you don't know yet, that's why you ask these folks, that's why you do this. So there's somebody that had a need, had no idea that was going to be available. Carolee meets with her, goes through the whole thing. Oh my God. I get to use that thousand dollars. I don't have anybody to drive me to the doctor. 00;14;12;10 - 00;14;28;03 Cary Hall I can't drive whatever the case may be. Oh, you got $1,000 now on a debit card. Go do what you need to do. Those are the kinds of things you need to know. And the way you get that information is by dealing with somebody like the folks at RPS Benefits by Design anywhere in the country, they can help you. 00;14;28;03 - 00;14;50;14 Cary Hall It doesn't matter where you are. They've got plans all over the country. They can tell you what makes sense of what doesn't make sense. Let's shift gears a minute, Marie. I want to talk about customer service, because, you know, it's a funny thing I say and I've had people say this to me that the word service is gone out of customer service, you know, And it it happens more often than not. 00;14;50;14 - 00;15;11;17 Cary Hall You call a major company and you want help with something. You're getting a phone center in Guatemala. Okay. And if you can understand what they're saying, you might be able to get something done and maybe you won't. Okay. Now, there are exceptions to that rule. I mean, there are there are certain companies like Blue Cross Blue Shield of Kansas City, you know, just one for the third time, the J.D. Power Award. 00;15;11;19 - 00;15;33;04 Cary Hall We use Spectrum cable service. I am amazed those people answer the phone when stuff breaks or something goes wrong, they actually do something. I mean, there are so there are companies that do get it, but there are so many companies that don't. And a lot of these insurance carriers fall into that into that that troughed. And you see these these these celebrities on television. 00;15;33;04 - 00;15;48;06 Cary Hall William Devane, J.J. Walker, Joe Namath, I think they put him out to pasture. Mike Huckabee pitching these Medicare plans. You're calling some call centers somewhere. What happens when they have a claim issue or a provider issue as they're trying to figure out a prescription drug? 00;15;48;09 - 00;16;11;29 Maria Ahlers You got to take care of it yourself. I mean, those celebrities are great to look at on TV, but they're not there to help you. You're right. You're right. Yeah, But really, when you call these numbers, they don't know where to start. They don't know how to get the answers or they'll just give you the information to call the call the 800 number in another “press 00;16;11;29 - 00;16;17;25 Maria Ahlers one for this”, “two for this”. When you call us, we help you with that claim. We advocate for you. 00;16;18;01 - 00;16;32;20 Cary Hall So here's this is a point I want to make. Okay? I used to have a commercial that I ran called You can either call us at Benefits by Design, before Benefits by Design became RPS Benefits by Design, I said, you can either call us or you can call the one 800. I don't give a damn number at the carrier. 00;16;32;25 - 00;16;52;15 Cary Hall And what I meant by that was what Maria just talked about. So when you go to that call center that J.J. Walker sent you and you you you connect with somebody and wherever they may be, it's going to sell you that policy that they want you to buy. Now, three months later, four months later, five months later, you've got a problem with the prescription drug. 00;16;52;18 - 00;17;01;15 Cary Hall Maybe they're telling you it's not covered. You don't understand the formulary or you want to go to a specific hospital that may or may not be in the network. Try calling them and see what you get. 00;17;01;19 - 00;17;27;17 Maria Ahlers That's right. We also have what we call a customer service retention specialist, where she will follow up with you after you enroll to make sure that your coverage is exactly what you need and to also check in to make sure that you don't have additional questions afterwards. So you have a direct line to her that you can call not only just our customer service specialist, but also to Carolee and all of our other Medicare specialists that are certified. 00;17;27;21 - 00;17;46;19 Cary Hall So there's actually somebody there that's going to help you. Yes, that's yeah, Yeah. And and, you know, that's important. And it's important to understand that they know the ins and outs of these Medicare policies. And like I said, in the next segment, we're going to talk about this because there are a host of things that are going on out there that you may not be aware of that can impact you directly. 00;17;46;24 - 00;18;15;17 Cary Hall But the disconnect, Maria, between these national call centers and the people that they have pitching this stuff, I mean, willing to vein sells everything from from coins to Medicare to I mean, it's just remarkable to me. That man's a busy man. So, yeah, their knowledge of Medicare is zero, okay? They are strictly pitchmen for this stuff. And they're throwing you into some national call center that that person's 99% probably not in your town or your city. 00;18;15;17 - 00;18;35;20 Cary Hall Okay. And you're going to be talking about hospitals, doctors, all these different things. And A, do you get good information? But the second piece of that is not if when something goes wrong, when there's a claim issue, when there's a provider issue, when there's a prescription drug issue, how do you you know, how do you how do you get that solved? 00;18;35;22 - 00;19;00;28 Maria Ahlers Yeah. So we've had clients where they're at a doctor's office and they say, I'm having my coverage problems with my coverage. They call Carolee and Carolee gets on the phone with carriers. They figures it out so they can continue to go with their appointment, attend their appointments. So that's the the the benefit of using us is having someone to call. 00;19;00;28 - 00;19;09;25 Maria Ahlers When you have a problem, that's when you need to speak to someone, not just selling me the product, but being there to support me through the process. 00;19;09;26 - 00;19;22;27 Carolee Steele I piggyback on that because a lot of these people will they want to put down a sale. What we honestly do is we take care of the people regardless of what it is. We take care of the people. And in the end, I think that's what counts. 00;19;22;29 - 00;19;35;00 Cary Hall At that point. If if they call you and they're on a policy and you review the policy and there's alternatives out there, but the alternatives are no better than what they've got, you're not going to try to sell them for that. You're going to tell them, stay put. 00;19;35;00 - 00;19;36;02 Carolee Steele Yep. 00;19;36;05 - 00;20;07;11 Cary Hall That's the difference, folks. That's a big difference. The phone number 877 385 2224. You want an evaluation, you want to look at what you got. Maybe that's your mom, your dad, your grandfather, whatever, or the website RPS Benefits by Design inc dot com. Once again, the phone number 877 385 2224. They're happy to talk to you. 00;20;07;13 - 00;20;24;08 Cary Hall Welcome back. You're listening to America's Healthcare Advocate show broadcasting coast to coast. Across the fruited plain here on the HIA Radio Network. You can find out more about us by going to our website America's Healthcare Advocate dot com. Look, if you've got a question or comment or anything, send an email to us. I get people sending me e-mails all the time. 00;20;24;08 - 00;20;39;20 Cary Hall They need help with something. We're happy to help you. Okay. Doesn't matter where you are or what the issue is. If I can help you, I'm more than happy to do it. Go to the website America's Healthcare Advocate dot com. By the way, all the shows are on those 14 podcast platforms I named in the beginning of the show. 00;20;39;25 - 00;20;54;27 Cary Hall If there's a platform out there we're not on, somebody needs to tell me, okay. And the shows are all posted on YouTube. So the videos are up there, the audio is up there. And obviously if you're in one of the areas where we have one of our 200 radio station affiliates, you can certainly listen to us on AM & FM radio. 00;20;54;29 - 00;21;14;25 Cary Hall All right. So now let's go back to this Carolee and let's list. I want to do some specific here. I want what I'm trying to do here is illustrate to you what you don't know and how what you don't know can hurt you. So let's just start with one carrier that made a change to their formulary. Explain what a formulary is for me and what they did. 00;21;14;27 - 00;21;15;28 Carolee Steele Well, one. 00;21;16;00 - 00;21;21;20 Cary Hall Thing for this year, we're not naming the carrier is we can't do that just yet, but we want you to see what we're talking about. 00;21;21;20 - 00;21;45;06 Carolee Steele So in 2024, they've come out with a plan that has a very significant low maximum out of pocket. So what you're exposed to, however, digging in a little deeper, they have raised one of their Tier three co-pays. Now, tiers are where your drug lies on a formulary. So you have Humira Yeah, Humira or Trulicity? 00;21;45;06 - 00;22;04;22 Cary Hall Eliquis Yeah, let's just let's just use HUMIRA. So prescription Humira is $4700 a month. So now what did they do? Tell me now I've got HUMIRA. I'm on this plan Tier three. I didn't know they changed the formulary because I didn't ask anybody. I'm on Aetna and I just or United or whatever it is. And I just renewed because that's what I'm already on. 00;22;04;23 - 00;22;09;19 Cary Hall Right. I didn't bother to get it reviewed, but I went to get my HUMIRA and what happens? 00;22;09;21 - 00;22;20;23 Carolee Steele Well, some of their Tier three has now gone to a 20% co-pay. So if you co-pay a $4700 retail pharmacy, that is quite a lot of money. 00;22;20;28 - 00;22;45;07 Cary Hall So now you just want you just wound up being eight eight. That's $800 for that prescription that you get to pay $800 plus. Okay. That's what I'm trying to explain here. If you don't know what you don't know. Okay. And these folks do, because that's all they do. All right. And that's the kind of thing that could be a huge mistake if you you're taking that Humira because, you know, you've got whatever maybe you've got colitis, Who knows? 00;22;45;07 - 00;23;05;06 Cary Hall You know, maybe it's an arthritis situation, whatever it may be. But you're taking Humira because it works and the plan you're on now covers it and you have a co-pay. Okay, that's great. Okay. But they just change tier three. So what was the other thing that she said that was interesting there? They lowered their out-of-pocket, Max, so they looked like they've got better benefits. 00;23;05;06 - 00;23;21;03 Cary Hall But if you get in the weeds, you may not be in that situation. It may be a totally different situation. Now, you don't have a tier three drug and for you, that might make sense. Okay. Of course, the question I was asking myself is what happens if I wind up having to have one? 00;23;21;03 - 00;23;34;28 Carolee Steele You have to have one, correct. And every year all of the carriers that have Medicare Advantage plans will send out an annual notice of change to each person. But not everybody goes through it with a fine tooth comb. And that's where we come in. 00;23;34;28 - 00;23;38;05 Cary Hall Yeah, I would say about 90% of people winds up in the circular file. 00;23;38;05 - 00;23;51;17 Carolee Steele So they know, Oh wow, the out-of-pocket is the same. The specialist is only raised $5. But you really need to take a, you know, a deeper dive. That's why we're here is to be able to review what they have. Does it fit their needs? Does it, you know, fit what they need? 00;23;51;19 - 00;24;10;11 Cary Hall Yeah. And so now let's reverse that scenario and let's say, whoa, where can I get a better benefit that I have now? So it they're one of the major carriers out there. Here in the Kansas City Metro is now offering a debit card with $2,000, is it $2000? 00;24;10;11 - 00;24;11;07 Carolee Steele Two-Thousand 500. 00;24;11;07 - 00;24;29;23 Cary Hall $2500 debit card. And we repeat that, a $2500 debit card, you can take that debit card and you can use it for anything you need to use it for. You can use it for dental. You can use of vision, hearing aids, over-the-counter medications, whatever the case may be. That's a $2,500 debit card. It that's part of the plan. 00;24;29;26 - 00;24;44;10 Cary Hall Nobody else has that particular benefit on the other carriers right now. That's something brand new that they're offering. And you can pay another $25 a month for an additional $2,000 for dental. Correct. 00;24;44;10 - 00;25;05;26 Carolee Steele And that 2500, somebody may have a huge like they need dental work that year, they'll you're going to use all that 2500 for dental if they want to or if they can split it up like I need frames lenses and I need a little bit of dental and I can use some for over-the-counter. That's what's nice about that flexible benefit is because it's you can use it how you need it. 00;25;05;29 - 00;25;24;05 Cary Hall Yeah. So let's take that scenario just a second so you know you're going to have major dental work this year. Here's a plan that's got $2500 debit card. You can use and, oh, if you pay another $25 a month, they add another $2,000. Now, you can go to the dentist. You have $4500 to spend. That's a little bit different. 00;25;24;09 - 00;25;40;18 Cary Hall Okay. You have $4500 to spend your own in-network dentist. So essentially you wind up with $6500. I'm just doing this top of my head, but you wind up about $6500 worth the benefit because you get the network discount and you got $4500 on a debit card you get to use. That's pretty. 00;25;40;18 - 00;25;42;04 Carolee Steele Strong. It is very strong. 00;25;42;04 - 00;25;59;21 Cary Hall And it's a large if you're that person that knows you're going to need maybe you need dentures, maybe you need a crown, maybe need a bridge. It can be paid for. You don't pay for it, but you're not going to know that. Okay. If you don't sit down with somebody and talk to them, maybe you're on a, you know, a plan with another carrier and you're not going to get this information. 00;25;59;22 - 00;26;22;02 Cary Hall You're not going to get it because they're not sending you a plan notice of change because you're not on their plan. But if you were to call RPS Benefits by Design at 877 385 2224, you would know that because Carolee Steele or Joyce Thompson or one of the other folks over there is going to take the time to go through this and explain it to you and say there is a better benefit over here you might want to take a look at. 00;26;22;04 - 00;26;31;28 Cary Hall Okay. So let's talk a little bit more about, you know, there were changes that we can see coming this year. Do we see drastic changes in the plans or are they pretty much stabilized? 00;26;32;00 - 00;26;48;06 Carolee Steele They've they've pretty much stabilized. I think all of them still have a zero premium. Most of them have gotten rid of their deductibles for any of their medical services, which is good. Really the out-of-pocket maximums really haven't changed a lot. 00;26;48;09 - 00;27;07;14 Cary Hall Yeah. So let's talk about that because, you know, I remember back in the day when I was doing this and it wasn't that long ago, it was long enough people would look at that out-of-pocket maximum and go, Oh my God, that it's $4500 or $3500, whatever it is, it's not a deductible. No, the problem is that that's that's what people equate it to. 00;27;07;17 - 00;27;15;18 Cary Hall Well, I'm going to have to spend $3500 or $4500 or $3100 before the cover anything. Will you explain that, that how that works? 00;27;15;25 - 00;27;44;01 Carolee Steele Well, the out-of-pocket maximum is what you are, what you're going to be exposed to if you used everything. So but most people, they will go to a primary care physician, zero. They'll go to a specialist, $30. They'll go to and have some lab work done or an x ray, $10 tip for the x ray. So they kind of accumulate and it's co-pays and co-insurance is when you hit that maximum out of pocket, then any A and B Medicare covered service, the carrier will pay for it past that point. 00;27;44;01 - 00;28;02;13 Cary Hall So the largest expense you typically incurs in patient hospital and I don't know what the number is now, but it used to be like $250 a day. You're responsible for for the first five days. So there it is. Okay. So now now you're looking at $1250. If you're hospitalized and you've got a hospital bill of 70 or $80,000. 00;28;02;20 - 00;28;10;10 Cary Hall So when people get hung up on that, I would always go back them and say, the chances of you ever hitting this are pretty slim. 00;28;10;12 - 00;28;21;09 Carolee Steele Well, a lot of people are used to their employer coverage where they have a large deductible, and so they know that they've got to meet that if they go into surgery, they've got to meet that and then a co-insurance and then the out-of-pocket. That's not how this works. 00;28;21;11 - 00;28;38;12 Cary Hall So Maria if they if they're on a plan and then they're kind of lost, they're like, I don't know, I signed up for the plan. It's a good plan. I'm happy with it. They're halfway through the year and they call, how do I find out on my own? How do I find out how much money I spent, what I have left, and what what's my responsibility going to be? 00;28;38;16 - 00;28;39;22 Cary Hall They can call. 00;28;39;23 - 00;28;59;22 Maria Ahlers They can call us and we'll reach out to the carrier and get the information for them. Again, you're speaking to a live person, and I think that's the key. I don't know about you, Cary but my parents, they don't like the automation. They grew up in an era where you just pick up the phone and you talk to someone and ask the question. 00;28;59;22 - 00;29;10;17 Maria Ahlers It doesn't matter what documentation you have. I want to speak to someone. I want to have that conversation, and I want to understand what I need to do to get this covered or how much it's going to cost me. 00;29;10;17 - 00;29;30;23 Cary Hall And you know, that's funny because we can talk about almost anything across the spectrum in terms of services, but when you call a large company, typically what you get is there's at least five voice prompts. I say, I recently had a problem with a bank, okay, where they had done some reporting to our credit bureau, which is 100% wrong. 00;29;30;23 - 00;29;53;07 Cary Hall They'd actually cashed the checks and said they didn't get paid. And I'm like, I got the checks right here. You did get paid. But in order to get to a customer service person, I had to go to at least six voice prompts and then I got the wrong customer service person. But at least it was somebody who answered the phone and then they connected me to the customer service person in that department who, by the way, turned out to be very nice and did a wonderful job and got it taken care of. 00;29;53;12 - 00;29;57;13 Cary Hall But my God, it took me 20 minutes to get to the person I needed to talk to. 00;29;57;15 - 00;30;06;09 Maria Ahlers Yeah, and time is precious. And we know people are impatient because they have a need, they have an issue and they want it resolved. 00;30;06;11 - 00;30;26;10 Cary Hall They want it resolved, and they want somebody that's there to help them. And that's the point, at RPS Benefits by Design they're your advocate. They work for you. They don't work for the insurance company. They work for you. So if you want help, they're there to help you. If you want an evaluation, I urge you to do this. Really take a few minutes, pick up the phone and call them or go to the website, fill out the landing page. 00;30;26;16 - 00;30;49;07 Cary Hall The website is RPS Benefits by Design dot com. The phone number 877 385 2224. Speak to the lovely Carolee Steele or Joyce Thompson or one of the other great people over there. They're happy to walk you through and tell you what you're doing makes sense or doesn't make sense. Stay tuned. We'll be right back after the break. 00;30;49;07 - 00;30;52;24 Cary Hall Here on America's Healthcare Advocate. 00;30;52;26 - 00;31;13;16 Cary Hall And welcome back. You're listening to America's Healthcare Advocate show, broadcasting coast to coast here on the HIA radio network. In studio with me, Carolee Steele and Maria Ahlers from RPS Benefits by Design. If you want some help, maybe you want to talk about your mom's plan or your grandmother's plan. Call them 877-385-2224. 00;31;13;19 - 00;31;32;17 Cary Hall It doesn't cost you anything to talk to these folks, okay? They can help you. They're happy to help you. 877-385-2224 Anywhere in the country. It doesn't matter where you are, they can take care of you. They're happy to help you, whatever you need. The website is RPS Benefits by Design inc dot com. 00;31;32;24 - 00;31;52;26 Cary Hall We're going to switch gears. Don't talk about Medicare supplement. I'm on a Medicare supplement plan. I've been on it since we turned 65 with Blue Cross and Blue Shield of Kansas City. It's a great plan. I wouldn't trade it for anything. But you pay a monthly premium. No, zero premium. Okay. So a lot of folks are having these these plans go up in cost of year over year over year. 00;31;52;28 - 00;32;02;06 Cary Hall Talk about that. And and then the question is, what can they move off of that over to a Medicare Advantage plan or are they going to have to go through an underwriting process where they can be declined? 00;32;02;06 - 00;32;26;20 Carolee Steele That's a great, great point. We have some people who, you know, they may pay $300 right now for their Medicare supplement. And it's really kind of tough financially and so I always say, you know, that $300 times 12 because they it pay it monthly is $3600 when that amount kind of equals some of the out-of-pocket maximum, that's when you need to take a deeper dive into whether or not you need to look into some of that. 00;32;26;22 - 00;32;42;13 Carolee Steele I have people that will go on to Medicare Advantage say, Well, what if I but what if I have leukemia and I'm it? There is no underwriting, no medical underwriting. So they will not look at your medical history to go from a Medicare supplement to a Medicare Advantage plan during the annual election period. 00;32;42;16 - 00;32;56;02 Cary Hall So that's that's the whole point. Okay. And if you can go from a $300 a month to a zero premium, maybe that's something that makes sense for you. I'm not going to tell you it does or doesn't. What I'm going to tell you is that's why you pick up the phone and call these folks so they can say. 00;32;56;02 - 00;33;13;07 Cary Hall Also, if, you know, let's say you've got an RV motor home and you travel and you don't want to go on a plan that has limited benefits outside of where you happen to live. Well, talk about that, because now some of the plans like the Blue Cross Blue Shield plans, have national networks for that. That's no longer an issue. 00;33;13;07 - 00;33;31;28 Cary Hall That used to be a big issue, Medicare Advantage versus Medicare supplement. Now it's not Medicare supplement basically is you can go to any doctor, any hospital in the country as long as they take Medicare. But now under some of these plans, like the Blue Cross Blue Shield plan here in Kansas City, they've got network coverage around the country, right? 00;33;32;00 - 00;33;49;29 Carolee Steele Correct. And a lot of them have on the PPO. It just keeps getting more broad and more broad, like, for instance, Blue Cross Blue Shield of Kansas City on their PPO network. They have the Blue Cross PPO network sharing. So there's only like two states. But if you can go to Colorado, if you have a sinus infection, you're like, How do I want to go? 00;33;50;01 - 00;34;00;20 Carolee Steele I don't want to go all the way back to go to the emergency room and then go to a PPO network, Blue Cross doctor in Colorado for a zero premium, like if they were in Kansas City. 00;34;00;22 - 00;34;19;17 Cary Hall And that's a big deal. Okay, Because that was a big stumbling block before. So, again, if you're on a Medicare supplement and you know, Carolee said if it's starting to bite, okay, because these premiums go up every year, it's worth taking a look and seeing what what's available out there. That is not part of the Medicare. 00;34;19;17 - 00;34;40;14 Carolee Steele And on the Medicare Advantage plans, any emergency or urgent care service will always be considered as in-network, and that's world wide. So that's really mainly what we do. I mean, if we go to Colorado or we're going to go skiing, we're going to go to the emergency room if we break our leg, so any emergency urgent care service will be considered as an in-network service. 00;34;40;17 - 00;34;42;06 Carolee Steele So that's very important to know. 00;34;42;13 - 00;34;50;10 Cary Hall And the same thing applies, right, Maria? If they if they're on a Medicare supplement, they call on customer services use. Yep, you're right there to help them. 00;34;50;10 - 00;35;01;24 Maria Ahlers We are we can help them find the closest emergency room or urgent care facility. Yeah, we are right there for them. And again, they get directly to a live person. 00;35;01;26 - 00;35;18;24 Cary Hall And that's again, I can't say it enough times. You know, how frustrating is when you call someplace you have to go through all those waste prompts and try to get try to get some help with what you're trying to do. It can be very, very difficult. So we're coming to the end of the show. What else? What are we missing currently that we need to talk about the well talked about. 00;35;18;24 - 00;35;44;01 Carolee Steele My thing is there is not a one size fits all at all. And so being able to sit and go over their medical needs, their financial and a lot of it is, you know, what is their comfort level as far as risk and things like that. So we'll go over each person has their own individual needs and that is what is so important for them to come to us so that we can kind of evaluate that and put them where they are the best served and that. 00;35;44;06 - 00;36;03;04 Cary Hall So there's a combination of things there. If you listen carefully to what she said, it's not just your medical needs, it's also your financial needs. How does this play? A lot of seniors are on fixed incomes. Okay. And so these things are critically important to them. Can I afford this coverage? Am I better off making that move off that Medicare stuff that over to Medicare Advantage? 00;36;03;06 - 00;36;21;28 Cary Hall What are they going to be? The differences? And the other thing is like we talked about, there are a lot of changes on these plans that happen year to year. And if you don't know about them and you go ahead and you you sign up for something that you haven't had a chance to go through and understand, six months later, you might find out that's a problem. 00;36;22;01 - 00;36;33;12 Carolee Steele Absolutely. And to to kind of do a little bit of a pivot. I think it's really important. All of these people are turning 65, so they think, oh, gosh, I got to get on a Medicare plan. I've got to get. 00;36;33;20 - 00;36;35;14 Cary Hall Employer Sponsored health care versus Medicare. 00;36;35;15 - 00;36;52;09 Carolee Steele Correct. And so everybody's got to I've got to get on. I'll have a penalty, etc.. About a third of all people are working past the age of 65. So it's like, can I stay on my employer plan or do I have to move off? Well, it's critical to know all of the little pieces and nuances involved in that. 00;36;52;09 - 00;37;07;00 Carolee Steele If you have a company that has 20 or less employees, do you have a company that's, you know, over 20? It's different for each one of who pays first, Medicare, the employer. And it's so important to sit down with a Medicare specialist and go over all of those particular. 00;37;07;02 - 00;37;23;23 Cary Hall Because depending on what your employer pays, you may be better off moving to a Medicare Advantage plans. You may if you're paying 50% of that premium and you're 65, that's probably a pretty good sized chunk of change. On the other hand, if the employer's covering all of it, you know, then then it's probably not something you need to think about. 00;37;23;23 - 00;37;29;14 Cary Hall But there are reasons that maybe your spouse needs to get off the plan. So that's all part of what you do. 00;37;29;14 - 00;37;29;29 Carolee Steele Absolutely. 00;37;30;05 - 00;37;45;01 Maria Ahlers And to piggyback offense, clearly, if you have a group plan with us, we have account managers work with our Medicare specialists. So now we have visibility to your group plan and visibility to the options on Medicare to help you determine what is the best option you. 00;37;45;04 - 00;38;09;22 Cary Hall Yeah, and that again, it's all about service people. I mean the only difference between RPS Benefits by Design and another ten insurance groups out there that do this consulting group's brokers is customer service. Everybody offers the same products. The products are the products, okay? But it's about customer service. It's about taking the time to understand people's needs and not jamming things through to jump to the next deal. 00;38;09;22 - 00;38;31;19 Cary Hall That's not the way they do it at RPS Benefits by Design. Hasn’t been since I had the the company when it was Benefits by Design isn't now. They do a great job and they do. They care about the people that they serve. And if you want help. 877 385 2224. The website RPS Benefits by Design Inc dot com. 00;38;31;25 - 00;38;32;15 Cary Hall Thank you both. 00;38;32;21 - 00;38;33;07 Carolee Steele Thank you Cary 00;38;33;09 - 00;38;49;16 Cary Hall Do this again before it's over with for open enrollment. Sorry but this get let's get this gets us out of the gate and off the ground and now I'll leave you with this thought from Albert Einstein, the one who follows the crowd they usually get no further than the crowd. The one who walks alone is likely to find himself in places no one has ever been. 00;38;49;18 - 00;39;02;16 Cary Hall Remember, friends. It's a funny thing about life. If you refuse to accept anything but the very best. You most often get it. Thank you for listening to America's Healthcare Advocate Show Broadcasting coast to coast across the USA. Goodbye, America.