Danielle Roberts: What You Need to Know About Medicare

About Danielle Roberts: Danielle Roberts is a founding partner at Boomer benefits. Which is a National Agency specializing in Medicare-related insurance products since 2005. She’s been serving thousands of Medigap policyholders in 48 States. Boomer benefits help baby boomers learn the ropes regarding Medicare, a nationally recognized expert in the Medicare sector of the health insurance industry. Danielle is a past President of the Fort Worth chapter of the National Association of Health underwriters, and a Forbes financial council member. She’s been featured and or quoted by major news outlets around the country such as Fox, Yahoo, finance, and Business Insider. 

In this episode, Steve and Danielle discuss:

1. Why do people feel so overwhelmed about Medicare when they’re approaching age 65?

  • I think it’s because your whole working life, you’ve had someone choose your health insurance for you, you work for a company, that company has an HR department, HR department reviews, a bunch of group health insurance plans, and they come and say here, you know, you can sign up for this plan. Here’s what it’s going to cost you out of your paycheck. And that’s what happens. Maybe you work for a company that gives you a choice between a PPO and an HMO they have two plants to choose from, but you never have to do any of the heavy lifting and learn what deductibles and coinsurance are, you know, you just sign up and go with whatever insurance that’s given to you. Well, when you turn 65, and you’re retiring and you’re leaving that group health insurance whenever if it’s at 65 or later. Either way, you’ve got to learn this National Health Insurance Program, which is a beast with four parts, 10 supplements, and literally thousands of Medicare Advantage or Part D drug plan options. 

2. Why haven’t they made it easier to comprehend or done some type of Medicare course to help people get introduced and acclimated with Medicare?

  • Yeah, you’re speaking my language. We have a private Facebook group where we allow people to join and ask their Medicare questions. I have heard that same question. Probably hundreds of times, like people will say, Why didn’t anyone prepare us and I often like to say, there should be a class when you’re 50 that you have to take could be online, and they could do it in an hour, but preparing you for things that people generally don’t know about Medicare, namely, that it’s not free, that you’re going to pay for it, and also that it doesn’t cover 100% of the cost of your healthcare so that you have time Get ready for that. Because we have met over the years, many, many people turning 65 getting ready to retire who were just blown away to find out that there’s a cost to this healthcare that they’re going to pay their whole life, that it’s going to be deducted from the cost, their social security check, and they’re not ready. So we’ve seen a lot of people decide to work a few more years because they were so caught off guard. So the government really does need to do a much better job. They send out a handbook. It used to be mailed to you now not even everyone gets the book in the mail. There’s some legislation too, that’s in Congress right now to take place to try to do a better job of preparing people for when they should enroll. So they don’t end up with penalties that they incurred just because they didn’t know when and where and how they should have signed up for Medicare.

3. Is it because they’re so confused or just so not in the know about what it actually involves and what it’s gonna entail? Usually when there’s things that people don’t really know anything about, and they’re a little nervous about, they tend to avoid it. 

  • Yes, people will procrastinate until the very last minute, or they just don’t make any decision at all. They sometimes end up in trouble for that. One example that we’re dealing with a lot now is that people who don’t have employer insurance who’ve been insured the last few years through the private health care exchange, they have had a subsidy which, which helps to make that insurance, very inexpensive for them. So they might be paying 50 or $100 a month for a health insurance plan because the government picks up part of the cost of the premium under the Affordable Care Act and so they’re like, well, I love the insurance coverage I have I just not going to sign up for Medicare. Well, what they find out later, is that it was never intended that the ACA Plans replace Medicare, they’re supposed to leave them and enroll in Medicare at 65. So not only will they pay a late enrollment penalty for signing up for Medicare because of that, but furthermore, once the government catches up with them, they’ll make them pay back all the subsidy dollars that they’ve been given since age 65. And you can just imagine there are literally thousands of people in that bucket who don’t know any better. So it’s so important that people start doing their research early. The early 60s is a good time, but certainly no later than age 64. You need to dive in and learn the parts of Medicare and learn the enrollment periods and familiarize yourself with all that so that you don’t accidentally make a huge blunder that is going to affect your coverage and what you pay for it for the rest of your life.

4. Can you fill in our listeners on exactly what that entails when you start being eligible for Medicare as far as price?

  • So part of the reason people think Medicare is free is that during your working years, you pay FICA taxes, and you see on your paycheck stub, the amount that’s pulled out of your paycheck to go toward Medicare and to go towards social security. So people think that they’re prepaying and that Medicare will cost them nothing when they get there. And on one part, that’s true, Part A, which is your inpatient hospital coverage under Medicare that is funded by the FICA taxes that you pay throughout your working life or if you were married to someone, you have to work at least 10 years here in the US or be married to someone who did to get Part A for free, and most people do work so about 99% of all Medicare beneficiaries, enrolling in part A will pay nothing for it. You can purchase If you a lot of times immigrants who are recent to America, maybe don’t have that work history, you can purchase it, but for most people, Part A costs nothing.

5. What exactly is Part A?

  • Part A is your inpatient hospital coverage. If you’re admitted into a hospital, Part A is the fund that pays for inpatient hospitals, skilled nursing, hospice, blood transfusions, things like that, that would occur in a hospital setting.

6. So that doesn’t cover all the other stuff? It only covers if you get sick, and you have to go into a hospital or you have to get skilled nursing?

  • Sometimes, people who can’t afford or didn’t know they have to pay, won’t sign up for the Part B which is the outpatient coverage, and that’s a big mistake if Medicare is going to be your primary coverage if you don’t have other coverage, such as through the VA or through retiree coverage through an employer, because although Part B does pay for outpatient things like you and I would think of as outpatient like doctor visits and lab work, it also covers things which may happen in the hospital because physicians perform services at a hospital and physicians fall under Part B. So if you were to have outpatient surgery or chemotherapy or radiation in a hospital, Part B is actually the part that covers those services. Part B is not free currently in 2020. The base premium, the standard base premium for Part B that most people pay is $144.60 per month. That typically goes up a little bit every year. People in higher income brackets about 5% of Medicare beneficiaries pay substantially more than that because they’re in a higher income bracket. 

7. What about the senior or the aging person who doesn’t want to pay $144 for part B, and has either a pension which includes health benefits or is still working and has health benefits, do they need to get Part B?

  • They don’t. If you work for an employer, past age 65, and that employer has more than 20 employees, then you can keep your employer coverage and it’s going to pay primary and Medicare will pay secondary. 

8. What is Part C?

  • Part C is the Medicare Advantage program. To understand how that works, I’ll first state that when you have your Medicare benefits in place. They work similarly to other insurance that you’ve had in the past when you have employer group health insurance. When you go to the doctor, you have a copay. If you go to the hospital, you pay a deductible. Well, Medicare has those same things. You have a deductible when you go to the hospital, there’s an outpatient deductible, and then Medicare covers only about 80% of your outpatient expenses. So you need some sort of supplemental coverage that’s going to cover that other 20% and also pay those deductibles for you. So you could choose to enroll in a traditional Medicare supplement that goes alongside the original Medicare that picks up those things for you or you could opt for the Medicare Advantage Program instead. And that is just a way where you can get your original Medicare Part A and B benefits through a private insurance company that operates a local network in your area.

9. What’s the difference if someone wants to do Part C and Part D, they can either get that through Medicare, or they could get it through private companies such as Boomer Benefits?

  • The Medicare Advantage program is not something Boomer Benefits offers, you would enroll in a doctor, a private insurance company, and all the same companies that you’re used to that operate in the under 65 world. They offer Medicare supplements and Medicare Advantage plans. So in your local area, you might be signing up with United Healthcare or Blue Cross or Aetna or Cigna Anthem. There are dozens of carriers that offer these plans. The main differences are with original Medicare and a Medicare supplement. Medicare is the primary payer and if you have a Medicare-approved claim which Medicare approves most medically necessary care. Medicare pays its share and then sends the rest of your supplement company and the supplement company picks up their share, leaving you little out of pocket. And the advantage of sticking with original Medicare and going that route is Medicare doesn’t have a network There are over 1 million providers that participate in Medicare across the United States. So you can see any doctor you want anytime you don’t have to pick a primary care doctor, you never have to get a referral.

10. If I was over 65 I could use any doctor, even in another state under my part C?

  • Original Medicare with a Medicare supplement is the one that you could see any doctor Part C is the one that has a local network. 

“What’s really important to know Is that Medicare has election periods and you need to know how they operate and when to use them.”

                                                                                                        —  Danielle Roberts

To find out more about the National Injured Senior Law Center or to set up a free consultation go to https://www.injuredseniorhotline.com/ or call 855-622-6530

Connect with Danielle Roberts:  

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Website: https://boomerbenefits.com/
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Phone: 855-732-9055 


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Show notes by Podcastologist: Kristen Braun

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