Medicare

YFP 366: Your Medicare and Long-Term Care Questions Answered

Posted on July 4, 2024July 1, 2024 by YFP Media

Tim Baker, YFP Director of Financial Planning, breaks down Medicare and long-term care insurance and what to consider when deciding on a policy.

Episode Summary

Tim Baker, YFP Director of Financial Planning, breaks down the importance of long-term care insurance in retirement planning, highlighting the need to carefully consider the cost of these policies and how they fit into one’s overall financial plan.

Tim also discusses Medicare parts A, B and D and the importance of understanding the enrollment period to avoid paying penalties.

About Today’s Guest

Tim Baker is the Co-Founder and Director of Financial Planning at Your Financial Pharmacist. Founded in 2015, YFP is a fee-only financial planning firm and connects with the YFP community of 12,000+ pharmacy professionals via the Your Financial Pharmacist Podcast podcast, blog, website resources and speaking engagements.

Tim attended the United States Military Academy majoring in International Relations and branching Armor. After his military career, he worked as a logistician with a major retailer and a construction company. After much deliberation, Tim decided to make a pivot in his career and joined a small independent financial planning firm in 2012. In 2016, he launched his own financial planning firm Script Financial and in 2019 merged with Your Financial Pharmacist. Tim now lives in Columbus, Ohio with his wife (Shay), three kids (Olivia, Liam and Zoe), and dog (Benji).

Key Points from the Episode

Medicare and long-term care insurance with questions from the community. [0:00]
Long-term care insurance costs and factors that affect premiums. [4:10]
Long-term care insurance policies, including elimination periods and riders. [10:23]
Long-term care insurance policies and their importance in retirement planning. [17:28]
Medicare penalties for late enrollment, including Part A, B, and D. [23:15]
Medicare changes and penalties, with tips for avoiding them. [29:40]

Episode Highlights

“Start assessing what kind of policies you want and what you want to do and what your plan for long term care in your 50s. The sweet spot to purchase a policy is in that 55 to 65 year old range. If you’re too early, you’re paying premiums for a long time and you may not reap the benefit for 20 or 30 years. If you’re too late, you’re paying much more in premiums or you could even be denied. So unlike most health insurance, you can be denied for pre-existing conditions. There’s really that zone, that sweet spot – the Goldilocks zone where you really need to kind of get this just right.” – Tim Baker [4:32]

“A lot of people think you need a 100% solution to put my kids through college or you need 100% solution for this. It’s not about that. It’s really about providing a baseline benefit for you that you can then pull the levers on other parts of your financial plan to form a fully comprehensive plan with regard to long term care.” – Tim Baker [9:58]

“I think the main misconception about long term care is that Medicare is going to cover this and it really doesn’t.” – Tim Baker [23:51]

Links Mentioned in Today’s Episode

Episode Transcript

Tim Ulbrich 00:00

Hey everybody, Tim Ulbrich here and thank you for listening to the YFP Podcast where each week we strive to inspire and encourage you on your path towards achieving financial freedom. On this week’s episode, we take questions from the YFP community on Medicare and long term care insurance – two critical, yet often overlooked, and might I say boring, parts of the financial plan. We discussed when it makes sense to purchase Long Term Care Insurance, what policies typically cost penalties for late enrollment in Medicare and policy changes and trends for both long term care and Medicare that listeners should be aware of when planning for the future. Now as we crossed the midway point of the year, it’s a good time to check up on your financial progress for the year and dust off those goals that you set back at the turn of the new year, which perhaps feels like a distant memory at this point. Whether you’re focused on investing in the future, paying off debt, saving for kids college, or growing a business or side hustle, our team at YFP is ready to help. At YFP we support pharmacists at every stage of their careers to take control their finances, reach their financial goals, and build wealth through comprehensive fee-only financial planning and tax planning. Our team of certified financial planners and our CPA work with pharmacists all across the US and help our clients set their future selves up for success while living a rich life today. You can learn more and book a free discovery call by visiting yourfinancialpharmacist.com. Again, that’s yourfinancialpharmacist.com.

Tim Ulbrich 01:29

Tim, welcome back to the show.

Tim Baker 01:34

Good to be here, Tim. Let’s do this thing.

Tim Ulbrich 01:36

All right. So at the time of this going live, we’re actually on our annual YFP mid year break, it’s a week that we take off every year as a team around the Fourth of July a week that we can pause, reflect, get some time with family and friends. So Tim, any any big plans for the family this year?

Tim Baker 01:52

No, it’s interesting, Tim, I am reading Michael Hyatt’s Free to Focus and he’s like, the way to kind of become focused is to is to do less. So I think it’s a good time to kind of stop and reflect on you know, the the first part of the year and then think about, you know, what’s ahead for the second half of the year, we have some friends coming in town that have young kids, so we’ll be spending the Fourth with them, but kind of just staying home and hanging out. How about you? Any big any big plans for the Ulbrich family?

Tim Ulbrich 02:22

Yeah, we’re hitting the road. We’re going to see Jess has family up in Bowling Green, to do some fireworks, Fourth of July stuff, see her grandma, and then we’re making a trip to Buffalo. My brother and his wife put in a new pool. So we’re gonna we’re gonna enjoy that with them for a couple days and make make the most of the week. Boys are super excited, great, great age for traveling. And it should be. It should be a fun week. So hey, when you when you figure out the Free to Focus, let me know how that works. I need to figure that out. So the genesis for today’s episode is, Tim, you led a webinar for us a couple weeks ago on Medicare and long term care insurance. And you know, this is a topic that I think we often think about, of course, we know it’s important, but it’s one of those topics, both of these topics where we’re like, ah, kind of boring, like, how much do I have to really think about this part of the plan. But as you shared, I mean, the engagement, the questions, the interest was, even exceeded our expectations, which is great. And so we decided, hey, let’s do an episode that focuses specifically on the community members questions around Medicare and long term care. Now, we have talked about both of these topics on the show before. We’ll link to these in the show notes. Episode 329 I brought on Certified Insurance Counselor Josh Workman to talk about Medicare selection and optimization. He had some great insights to share from his experience helping people with Medicare selection. And then episode 296, Tim, you and I talked about five key decisions for long term care insurance. So we’re not going to rehash the background of these topics, make sure to go back and listen to those but rather jump into questions that our community had on these two topics. So, Tim, let’s start with long term care. First question, which is probably I think, the most common question, which is, when do I need this policy? Right. So what is the ideal age range to purchase a long term care policy?

Tim Baker 04:15

And in the presentation that we did in early June, the I kind of talked about this as like the Goldilocks zone, right? So if you’re too early, it’s not great. If you’re too late, it’s not great. So the way that I have broken this out, Tim, is you start discussing this in your late 40s. Start assessing kind of policies and what you want and what you want to do and kind of what is your plan for long term care in your 50s and then really kind of get the sweet spot to purchase a policy is in that 55 to 65 year old range. If you’re too early, you’re paying premiums for a long time and you may not reap the benefit for 20 or 30 years. If you’re too late, you’re paying much more in premiums or you could even be denied. So unlike most health insurance, you can be denied for pre-existing conditions. So there’s really that, that zone, that sweet spot, so to speak, is the Goldilocks zone where you really need to kind of get this just right. And again, if you’re, you know, if you have chronic issues, maybe you do that earlier. But I think one of the questions we’ll talk about, what do these premiums look like, and I kind of have these different age bands, so we can kind of talk about that. But, you know, started discussing in your late in your late 40s, kind of start assessing, you know, your plan and 50s. And then and then have a policy that meets that plan, you know, in that 55 to 65 year range.

Tim Ulbrich 05:42

So, Tim, we’re officially in the decade, you said end of forties. So something we’ll be thinking about here in the not not too distant future, which is hard to believe. But let’s talk about costs, right? Because I think sometimes these policies certainly can have some sticker shock. Everyone’s situation, of course, is different. But what are we looking at in terms of average premiums of a standard long term care policy?

Tim Baker 06:06

Yeah, so before I get into that, like, I think one of the I think this was Lincoln Financial, you know, did it did a study that that showed, like, what couples are willing to spend on long term care insurance, I think, I think the number was like $2500 to $3,000 per year in premiums. So I had that in the back of my mind, as I was kind of researching, you know, this. So according to the 2023 Long Term Care Insurance Price Index, that’s put out by the American Association for long term care insurance, AALTCI. General estimates, and this is for this is for a policy that has an initial benefit amount of $165,000, it grows at 3%, compound inflation. So that’s kind of the general baseline. At age 55, for a single male individual, those premiums range from $1700 to $2,100 per year. So obviously, you’re in that that range of $2500 to $3000. Single females, unfortunately, ladies, your premium jumped quite a bit, you tend to live longer than men. Single female, it’s actually $2675 to $3,600. And then a shared benefit, so a couple that kind of combines their benefit together is is $3,000 to $4,800. So that’s at age 55. It jumps age 60, for a single male goes from $2100 to $3000. So that’s up from $1700 from $2100, single female jumps from $2675 to $3600, to $5000. And then the couple $3800 to $5500 combined. And then lastly, it’s 65, single male $2600 to $3135. So that’s a jump from the $2100 to $3000, single male $4230 to $5265, and then the couple $5815 to $7150. So, and I would say, Tim, that the factors are influencing these premiums, the probably the big one here is going to be the inflation protection. So it’s probably the most the most expensive rider that’s out there. And if you actually tie it, I don’t even know if they sell them. I don’t think they sound like this. But they’re they’ve been insurance products in the past to actually tie it to the CPI. I think they don’t necessarily do that. It’s like how you pick a 1% 2% 3% 4%. That’s going to drive the biggest cost to the to the you know, to the premium. Age of purchase, obviously, as we kind of outlined here is a big factor your health so health are healthier individuals will qualify for better rates, the benefit amount and duration. So a highly highly daily benefit or a bigger benefit pool. And a longer, you know, longer period won’t increase your premiums, elimination periods. Will I think it talks about this another in another question, the shorter the elimination periods and think about this as a time deductible or a deductive deductible that’s in time, results in higher premiums. I mentioned the inflation protection and then additional riders so, you know, other things that could be outside of inflation, shared care will increase the cost. So these are kind of the factors but you know, I think almost all being equal, you know, if we were to strip away the 3%, which again, that’s a major rider, I think they’d become a little bit more affordable. And I think if you’re looking at a baseline policy that that will allow you to age in place, meaning like age in your home as long as humanly possible. I think if you can look at these policies almost as like a coupon for that care. Not that you know, we talked about this. A lot of people think like oh, I need 100% solution to put my kids through college or I need 100% solution for this. It’s not about that it’s really about providing a baseline benefit for you that you can then pull the levers on other parts of your financial plan other other, you know, assets that you have to then, you know, form a fully comprehensive plan with regard to long term care.

Tim Ulbrich 10:22

Yeah. And Tim, as you share that, it reminded me of bringing Cameron Huddleston, on the show who wrote mom and dad, we need to talk we had her on episode 321. Navigating some of those financial conversations with aging parents, and some listening might might be thinking about this as the coverage for themselves. Some listening might be thinking about this as, hey, what about my parents, right, that are aging? What what do they have in place, and obviously, there can be a direct line from their coverage or lack thereof and their own financial plan. And so, you know, when you’re talking about the different factors that can affect the cost to me, but I also hear in there is like, we’ve got to zoom out and understand, like, what are the desires and the needs? What what is the goal in terms of long term care, obviously, things may happen or not as we would like them to happen. But having some clarity on you mentioned, like care in the home versus a facility type of care, like, those conversations are going to be really important for us to think about individually, but also with our parents to then look at some of these policies and determine, you know, what we want these policies to be doing in the coverage.

Tim Baker 11:25

Right. Yep, exactly, right.

Tim Ulbrich 11:28

You mentioned riders a couple times before we go to the next question. Can you can you just define that for those that may that may be a new term as they’re looking at insurance policies?

Tim Baker 11:37

Yes, riders are things that they’re like, the kind of like, add on features. So when an insurance writer, you know, wanting like, like for a life insurance policy, a permanent policy, or a disability policy could be like a waiver of premium. So like, if you have if you’re deemed disabled, you could put a rider in that policy that basically says, if you are disabled, the policy will remain remain in force, however, you don’t have to pay the premium. For for the what we’re talking about is cost of living. As you know, things increase every year and inflation goes up, the policy kind of keeps pace with inflation, or at least there’s a flat rate. So all a writer is is a additional feature that’s bolted onto the policy that makes it more enticing to the policyholder holder. However, it often comes with expense, you know, it comes with an additional premium that’s tied to that. So that’s all rider is.

Tim Ulbrich 12:43

Great stuff. So we talked about what’s the ideal age range, we’ve talked about the average premiums, what goes into that costs, several different factors. You mentioned, some of those riders, age of purchase health, what the actual policy entails elimination period. Let’s talk about elimination period. That was one of the other questions that came through is, you know, is there an elimination period with a long term care policy similar to what folks might be familiar with with a long term disability policy? So if you could first define elimination period? And then answer that question?

Tim Ulbrich 13:11

Tim, as you’re sharing all of these nuances and details regarding long term care insurance policies, you know, as can be the case with buying insurance, right, you pull back the onion. And there’s another question to consider, another question to consider what the policy should be made up of which all informs the cost, right? And what we have to answer the question when it comes to insurance, whether it’s long term care, or long term disability life, whatever we’re talking about is, what do we need? And what do we not need? Right, because obviously, we want to have a certain level of protection, that’s going to protect the rest of our financial plan. But we also don’t want to be overspending on premiums so there’s an opportunity cost that those dollars can be used elsewhere in the financial plan. And I think this is important point to selfishly plug, the work that we do and other fee-only financial planners were when you’re engaging in that work in a fee-only relationship, meaning that you’re paying the advisor for the advice that they’re giving. And there’s not a compensation stream coming from the recommending of products that may or may not be in your best interests, we really can sit down and have these conversations of what do you need, what you not need, without there being a bias in the advice that’s been given. So important.

Tim Baker 13:11

Yeah, so the elimination period, as I mentioned, is kind of like, think of this as like, when you get in a car accident, and you are, so your deductible is $500, or $1,000. You have to pay that, you know, as part to kind of access the policies policy. So if I have a, you know, an accident, and I need work on my car, that cost, you know, $2000, for that, for the policy to pay out that $2000, I have to actually pony up the deductible, which is, you know, 500, or whatever it is. So it’s it kind of what it what it what it’s meant to do is create somewhat of a barrier to care, they don’t want these policies don’t want to be accessed or have claims against if they’re if they’re nominal or minimal. So in a long term care insurance policy, you pay that in time. So to back up, when we talked about when you know, the process of purchase and long term care, I kind of broke this up into five steps, it’s actually deciding when to purchase a policy which we talked about, it’s to choose kind of a monthly benefit. The third one is a truce of deductible, which I’ll break down here in a second and then four and five is that decide how long the benefit will be paid. And then the fifth one is decide, you know, what is what riders you want? Do you want an inflation rider or not? So, to go back to step three of choose a deductible, deductibles come kind of in all shapes and sizes. So in terms of a time you can get a deductible, that is, you know, the elimination period I should say that the deductible and time that is 30, 60, 90, 180 or 365 days out. The most common is 90. So the idea behind this is, once once a professional physician says, you know, Hey, Tim, you need help with assisted daily living, like the task of transferring or eating or whatever, then that’s when the clock starts. So if I have a 90 day elimination period, and the doctor determines that July one, then essentially on October one, and sometimes it takes another month to actually get the benefit, you know, October one or November one, that’s when actually the policy starts to pay out. Now, what I just described was a calendar based a calendar day elimination period, there’s really two types, there’s calendar day. And then there’s service day. So the calendar day is based on the total number of days from the start of needing care, i.e. that physician says, hey, Tim, you need care, regardless of how often you use services, as opposed to a service day elimination period, which is based on the actual number of days he received paid care. So think about when you think about long term care, it’s often intermittent care, you don’t have someone around the clock, maybe they come in, you know, three days a week to clean and help you do some things around the house. So there’s pros and cons on each on each, right. So if you have a service day, service day care, if you have a 90 day service day elimination period, and you receive care three times a week, it would take approximately 30 weeks to meet the 90 day. So we’re versus like, if you have you know, on that first example, July one, I need care, you know, October 1, I’m getting, you know, I’m getting my policy to pay. So, you know, there’s pros and cons of each, you know, typically the calendar days going to be more expensive than the service day. You know, if you if you only need intermittent care, and it’s it’s maybe even less than, you know, weekly, you need it, you know, once a week or whatever it is, and the maybe the service day, you know, works. So this, these these elimination periods is all about trying to find, again, the Goldilocks zone for what type of care you need, what you what you want to pay for your policy, and then adjusting it for that. So that’s the elimination period, Tim. So again, most common is the 90 day. I think, I’m not sure what is more common between service and calendar day, I think if you want more of a known timeline, then calendar is kind of what you want. But then, you know, again, that’s probably going to be more expensive when it comes to paying the premium. That you have the the overlap between advice and the sale of a product, there’s going to be a conflict of interest, because often often that sale of a product, you know, means there’s a commission that’s in place. And yeah, and I’ll bring up one of the things. You know, I feel like when I was presenting, you know, I think the the latest data says that a couple, a couple that’s age, age 65, see if I can bring up the number. A couple that’s a retired couple age 65 can expect to spend after tax $315,000 on health care and medical expenses during retirement.

Tim Ulbrich 19:14

After tax.

Tim Baker 19:15

Right. So and I think you might look at that be like, Oh, that’s not that bad. But like, a lot of people I look at that. I’m like, that’s a that’s a significant chunk of my, you know, traditional, like portfolio. Right? So and then the thing with this is that, you know, the last time I looked at this a year or two ago, like these numbers, they’ve jumped significantly. So, I think again, you know, if you’re and this is like if you think about like the biggest cost in retirement is really not like health care and medical expenses, it’s housing. So you know, if you think about this plus housing and that’s a significant chunk of a lot of people’s, you know, retirement nest eggs. So the the idea of behind, you know, long term care is to provide a baseline, again, you know, simple math, you know, you could spend $3,000 for 30 years and you know, spend, you know, $90 grand and give you that baseline, and again, you know, it can change. But to me, it’s about, again, getting those products in place for the plan that you’re trying to design without kind of some of those strings that you mentioned that are attached to that. So. Yeah.

Tim Ulbrich 20:27

Yeah, this is you’re talking, it’s all good reminder for me, you know, my conversation with my parents. We’ve had an open conversation. I know they have a long term care policy, I don’t know the nuances of the policy. I know they’ve been diligent in that work. I know, it’s something they’ve talked about, they’ve they worked through intensely. But obviously, the the next level of that is to really ensure that my brother and I have a understanding of what’s there as well. Before we move on to Medicare, last question, related to long term care is, are there any recent policy changes or trends in long term care insurance that our listeners should be aware of when planning for their future?

Tim Baker 21:06

Yeah, I kind of see three, the big one I mentioned already, is, I think there’s a big push towards the aging in place initiatives, the the longevity of a person of a patient increases, when they can age in their home for as long as possible. And actually, a lot of these policies, Tim, are really designed to provide as much care and benefits to do that. So whether that’s setting up things like ramps or handrails or modifying the home to make it better, to, you know, again, have more of a focus on in home care than in a facility, once you pivot to a facility. You know, it’s it’s, it’s, it’s better for you to stay in home as long as possible. So there’s, there’s a growing focus on aging in place programs. And also that include kind of like wellness interventions like home modifications, and, you know, use of technology to monitor health and provide care remotely, so kind of more of a telehealth type of stuff. The second one is shift into more like hybrid policy. So there’s an increase in preference for hybrid long term care policies, which are often combining long term care benefits with life insurance or annuities. So, you know, if you were to decide to peel off, you know, a couple $100,000, a quarter million dollars of your, of your retirement portfolio to create a baseline floor, so you know, what you get for security plus, what this annuity pays you for the rest of your life, there’s, there are riders that you can put in that also provides long term care. So these policies policies offer more flexibility. And it’s, it’s, it’s less about, like, a lot of people with really annuities and long-cares, like, you know, you kind of lose it if you don’t use it, right. So making them more attractive to consumers, compared to kind of a traditional policy. Right. So that’s, that’s, that’s another one is kind of that hybrid approach. And then the third one, is, we’re starting to see more chatter and action initiatives for public long term care programs. So states, like Washington have introduced public programs, called Washington’s called the Washington Cares Fund, which began payroll contributions in July of 2023. And the basically what they’re trying to do is provide basic long term care benefits to residents. So they have something in place, because I think the the main misconception about long term care is that Medicare is going to cover this and it really doesn’t. So I think certain certain state governments are looking at this as a way to set aside money for residents to have some type of benefit in place for the purpose of providing, you know, long term care.

Tim Ulbrich 24:15

Great stuff, Tim. A topic, we’re going to continue to come back to, as I know, there’s lots of questions out there from the community. And since you mentioned annuities in that second update, and you know, we’ve talked before about that concept of creating a retirement paycheck, creating a floor between social security and annuities, whether or not that’s the right fit is another discussion, but we did talk about annuities on episode 305. Understanding annuities, we did a primer for pharmacists. So if folks are hearing that are like, oh, I want to want to learn more. We’ve covered that before we’ll link to that in the show notes. Tim, let’s shift gears to talk about Medicare. And again, we’ve discussed this briefly on the show before, Episode 329 with Medicare selection and optimization. Many pharmacists are aware of the different parts of Medicare from the work that they do every day. So let’s jump into some specific questions. The first one being for Medicare Part D, is there, (D as in dog), is there a penalty if you delay applying?

Tim Baker 25:14

Yeah, so so Medicare Part D is for a prescription drug plan. So yes, there is a penalty if you delay enrolling in Medicare Part D, the late enrollment penalty is an additional amount added to your Part D premium. And it’s calculated based on the length of time you went without Part D. The big thing here, Tim, is that it’s permanent. So once that penalty hits, it’s gonna hit as long as you have a Part D. So the way they calculate it, this, it’s 1% of the national base premium beneficiary premium for each full month, you went without coverage. So, and this goes up and changes every year. So as an example, the in 2023, the National base beneficiary premium was $32.74. So it’s not a ton of money. 1% of that is 33 cents. But you know, if you miss three months, that’s a whole whole dollar that you’re permanently paying on top of that. So it adds up, it’s one of those things that you don’t want to miss. So this is again, if you if you forego enrolling in Part D, you want to make sure that you do that when you’re you know, general enrollment comes up. So that’s that’s the penalty for part D.

Tim Ulbrich 26:29

I think getting out in front of this, I’ve observed this time with my father-in-law and in my conversations with Josh, that we had on the show, Episode 329. This is just a big decision. You mentioned the permanent penalty, but also, this is people getting flooded with all types of information. Right? You know, I think there can be a paralysis just with the overwhelming amount of information. So starting this process early, making sure you’re doing research working with professionals that really understand this and have your best interests in mind is, is huge. The second question is what are the potential penalties for late enrollment in Medicare Part A, B, and D, we talked about D already. And are there any exceptions or circumstances where these penalties can be waived?

Tim Baker 27:09

Yeah, so so for Part A, most people don’t pay a premium for Part A, that’s kind of what your, you know, your payroll taxes already where you pay into Medicare while you’re working. However, some people do, do and if that’s the case, you have a monthly premium that may go up by by 10%. And you have to pay the higher premium for twice the number of years, you could have had Part A but you didn’t sign up. So again, most people, they’re going to, they’re going to dodge this because they’re not going to pay a premium for Part B. Again, just like Part D is that there is a penalty, and it’s permanent. So if you don’t sign up for Part B when you’re eligible. So this is your Part A is your hospital insurance, Part B is kind of easier is your outpatient, the penalty is added to your monthly Part B. So you calculate the this by looking at the penalty is 10% of the standard Part B premium. And I think in 2023, that premium was essentially $165, $164.90. So 10% of that, that that can add up, right. So and then the duration, you have to pay this penalty for as long as you have Part B the penalty is permanent and will be added to your premium. So if you delayed signing up for Part B for two years, your penalty would have been 20%- two years times to 10% of the standard premium. So in this example, your monthly premium would be a penalty, it would have been $164.90. But then, because you waited two years, the new premium is $197.88 cents. So more dire than prescription higher premiums, probably more punitive penalty. So this is really important as you are approaching your window. So just a reminder, you know your window, it’s the month before and after your eligibility date, so I should have this here. Here we go. So individuals that age 65, it’s a seven month period. So it’s three months before you turn age 65. The month you turn 65 and then three months after you turn 65 is your general or is your initial enrollment period. And that’s where you really want to make sure that you enroll in A, B and D at a minimum to avoid the penalties.

Tim Ulbrich 29:40

Great stuff there. Last question we have on Medicare, same one we heard on the long term care insurance side. Are there any recent policy changes or trends in Medicare that individuals should be aware of when planning for the future? And I guess we should say as we talked today, there’s a presidential debate tonight. I’m guessing this will become a topic in the presidential elections as it often is. So some of that will be hearsay, but anything that has been solidified or any changes that folks should be aware of?

Tim Baker 30:07

Yeah, and I’m going to answer this, Tim. And I want to go back to some of the exceptions that I didn’t answer for the question before. So the really the only things that I’m seeing for part D in for Medicare is related to part D. So starting this year, the 5% co-insurance requirement for Medicare Part D enrollees will be eliminated. So, I think what they’re what they’re trying to do is, is really go after high cost medications. So this is meant to reduce out of pocket. Beginning in 2025, though, there’ll be a $2000 annual out of pocket spending cap for part D, which will also provide significant savings with regard to high prescription drug costs. And then the two other trends that I’m seeing, is ones around consumer protection. So they really want the government really wants to kind of crack down on deceptive marketing practices. And so they don’t, they don’t want you know, companies that, you know, talk about these plans to kind of mentioned specific plans, and more oversight for like agent and broker monitoring to kind of, to kind of reduce predatory behavior. So kind of, you know, they want to prevent seniors from being pushed into a plan that they don’t necessarily want or need. And then the expansion of telehealth and digital health education is another thing in Medicare that they’re trying to, to focus on. To go back to the second part of the question that I didn’t answer, where the penalties can be waived. There are certain circumstances where the penalties can be waived. So if you are if you or your spouse are still working, and you have health care coverage through your employer, you can sign up for Part A during a special enrollment period without a penalty. And the special enrollment period typically lasts for eight months, after employment ends, or the group health coverage ends, whichever happens first. For part B, it’s the same thing. If you have, you know, coverage through an employer, that that can be, you know, something that, you know, avoids the penalty. And then Part D, if you have if you have like, coverage through your employer or TRICARE, or you’re a veteran, that, that that will waive the penalty. And then if you are in a disaster zone, like a disaster, like they’ll give you like a waiver for the penalty, if you can kind of prove that you were there or the extra help. It’s kind of a low income subsidy. If you didn’t sign up for Medicare, that’s another waiver. But you know, typically, outside of those, you’re gonna you’re gonna see that penalty. So that the kind of round out that second question there, Tim.

Tim Ulbrich 32:49

Great stuff. Tim. Lots of questions and engagement from the community on this topic. Be on the lookout – we have more webinars coming throughout the year, you can always find information on our website, yourfinancialpharmacist.com. If you’re subscribed to our newsletter, you’ll get updates there as well. We’d love to have you attend one of our future webinars covering a wide array of different financial topics for pharmacists at all stages of the career. And if you have a question on these two topics or another question, feel free to send us an email [email protected]. Again, [email protected]. And we’ll try to tackle that on an upcoming episode of the podcast. Now as we cross the midway point of the year, it’s a great time to check up on your financial progress for the year and dust off some of those goals that you set back at the turn of the new year. If you’re like me that perhaps feels like a distant memory at this point in the year. Whether you’re focused on long term care insurance and Medicare like we talked about today, or investing for the future paying off debt saving for kids college growing a business or side hustle. Our team at YFP is ready to help. At YFP we support pharmacists at every stage of their careers to take control of their finances, reach their financial goals and build wealth through comprehensive fee-only financial planning and tax planning. You can learn more and book a free discovery call with Tim Baker by visiting yourfinancialpharmacist.com. Again, that’s yourfinancialpharmacist.com. Tim, great stuff. We’ll be again back again next week.

Tim Baker 34:12

Yeah, sounds good.

Tim Ulbrich 34:16

As we conclude this week’s podcast, an important reminder that the content on this show is provided to you for informational purposes only and is not intended to provide and should not be relied on for investment or any other advice. Information in the podcast and corresponding materials should not be construed as a solicitation or offer to buy or sell any investment or related financial products. We urge listeners to consult with a financial advisor with respect to any investment. Furthermore, the information contained in our archived newsletters, blog posts and podcasts is not updated and may not be accurate at the time you listen to it on the podcast. Opinions and analyses expressed herein are solely those of Your Financial Pharmacist unless otherwise noted and constitute your permits as of the date published. Such information may contain forward looking statements, which are not intended to be guarantees of future events. Actual results could differ materially from those anticipated in the forward looking statements. For more information, please visit yourfinancialpharmacist.com/disclaimer. Thank you again for your support of the Your Financial Pharmacists Podcast. Have a great rest of your week.

[END]

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YFP 329: Medicare Selection & Optimization: Common Mistakes, Tips & Tricks

Posted on October 12, 2023October 11, 2023 by Tim U

On this week’s podcast, sponsored by APhA, Certified Insurance Counselor, Insurance Agent, and Medicare Specialist, Josh Workman, joins the show to cover Medicare 101 and considerations for selecting your Medicare coverage plan.

Episode Summary

Many people (including pharmacists!) aren’t fully informed about Medicare, the options they need to consider, and the pros and cons of each option. That’s why, in this week’s episode of the podcast, we brought on Certified Insurance Counselor, Insurance Agent, and Medicare Specialist, Josh Workman to give us a Medicare 101! Tuning in, you’ll hear about Josh’s role in the world of helping seniors navigate Medicare benefits, options for coverage, and the five main differences between Medicare Advantage and Supplement plans. Finally, he shares some words of wisdom for pharmacists struggling to answer Medicare questions for themselves, family members, and even clients.

About Today’s Guest

Located in the Akron Ohio area Josh Workman has been an insurance agent since 2010 with Medicare planning being his main area of focus. He started his career with Nationwide, but then moved to an Independent agency in 2014. Aside from helping individuals who are new to Medicare, he also works with professionals such as care facility coordinators, doctors and pharmacists as they assist their patients with Medicare plan decisions. Medicare can be extremely confusing so instead of the salesman angle, Josh takes an educational approach when helping his clients with Medicare Supplements, Part D Plans and Medicare Advantage Plans. One of his favorite parts of the job is teaching Medicare 101 classes to people who are new to Medicare.

Key Points From the Episode

What Josh does in the Medicare world.
The basics of Medicare and the timelines for selecting coverage.
Two main options for coverage when going onto Medicare.
Five differences between Advantage Coverage and Supplement Coverage.
A quick summary of the two plans and the pros and cons of each.
The kinds of plans Josh sees people choosing and why.
Some of the dangers of being influenced by marketing when choosing a Medicare plan.
Mistakes that Josh sees people making when buying a plan.
Advice for leveraging the help of a Medicare agent for pharmacists.

Episode Highlights

“A lot of people make an assumption that original Medicare – Part A and Part B, includes prescription drug coverage. It actually does not. The only way you can get Part D is through an insurance company.” — Josh Workman [0:10:46]

“If you have to pay medical bills, if you have a network, you’re probably going to be paying less for your insurance because you’re subjecting yourselves to these medical bills and to this network.” — Josh Workman [0:15:21]

“Medicare Advantage is less expensive. There’s a network and there’s medical bills. Supplement is more expensive, but it doesn’t have a network and it doesn’t have medical bills.” — Josh Workman [0:20:20]

Links Mentioned in Today’s Episode

Episode Transcript

[INTRODUCTION]

[0:00:00] TU: Hey, everybody. Tim Ulbrich here, and thank you for listening to the YFP Podcast, for each week we strive to inspire and encourage you on your path towards achieving financial freedom. This week, I welcome to the show Josh Workman, a Certified Insurance Counselor, Insurance Agent, and Medicare Specialist.

Aside from helping individuals who are new to Medicare, he also works with professionals such as care facility coordinators, doctors, and pharmacists as they assist their patients with Medicare plan decisions. We tap into his Medicare experience to discuss five key considerations for evaluating Medicare benefit options. You’ll find this episode insightful and helpful, whether you are evaluating benefits for yourself or helping patients or other family members navigate this process.

All right, let’s hear from today’s sponsor of the American Pharmacists Association and then we’ll jump in my interview with Josh Workman.

[SPONSOR MESSAGE]

[0:00:50] TU: Today’s episode of the Your Financial Pharmacists Podcast is brought to you by the American Pharmacists Association. APHA has partnered with Your Financial Pharmacists to deliver personalized financial education benefits for APHA members. Throughout the year APHA will be hosting a number of exclusive webinars covering topics like student loan, debt payoff strategies, home buying, investing, insurance needs, and much more. Join APHA now to gain premier access to these educational resources and to receive discounts on YFP products and services. You can join APHA at a 25% discount by visiting pharmacists.com/join and using the coupon code YFP. Again, that’s pharmacists.com/join and using the coupon code YFP.

[INTERVIEW]

[0:01:37] TU: Josh, welcome to the show.

[0:01:38] JW: Thanks for having me, Tim.

[0:01:40] TU: Well, this is a treat. You and I have known each other for a long time when Jess and I lived up in Northeast Ohio. Our families got to know each other well. I’ve always appreciated the work that you’ve done on the Medicare side. It’s taken us over 300 episodes, but I’m excited to finally bring this together to be able to tap into your Medicare experiences and knowledge. Thank you so much for coming on.

[0:02:03] JW: Yeah. Thanks again for having me, Tim.

[0:02:05] TU: Josh, as we were planning for this episode, and here we are in the month of October, we’re talking about all different aspects related to the health insurance part of the financial plan and we realize that Medicare really isn’t a topic that we’ve talked really much about, maybe not even at all, but it’s such an important part of the financial plan for those that are making that transition into retirement.

As we were planning for this episode, we were thinking about a few different groups that may find value in this, right? Of course, there’s individuals listening that are getting ready to make that Medicare decision for themselves and making sure that they’re optimizing that benefit selection. But perhaps, even a bigger group would be, “Hey, I’ve got aging parents that are going through this phase.” Or, “I work at a pharmacy and often I have patients that come looking for help in terms of Medicare selection and what are some of the things that I should be thinking about.” I know, Josh, in your work as well, you consult with individuals that are going through selection, but also work with other providers and facilities as well. Is that correct?

[0:03:05] JW: Yeah. Yeah, that’s correct. I’m working with individuals or maybe in a group setting, like a seminar setting is a lot of what I do. But then, yeah, working with pharmacists, working with doctors, working with assisted living facilities, all those types of professionals have questions and I’m able to help their patients as well.

[0:03:25] TU: Let’s start with some of the basics of Medicare, Josh. Pharmacists get really a slim amount of this in pharmacy’s glamour. We talked about health insurance at large. We talked about the different parts of Medicare. It’s been 15 years for me, perhaps more for others that are listening as well. Let’s start with some of the basics, Medicare 101, Parts A through D. Just break down for us what those different parts cover.

[0:03:49] JW: Yeah, sure. There’s two parts to what’s referred to as original Medicare. That’s Part A, like Adam. Part B, like boy. A would be hospital benefits. You’d use your Part A coverage, for example, if you were in the hospital staying overnight for a surgery. Let’s say, Part B, like boy, that’s going to be medical benefits. Think of that as more outpatient-related things, specifically, like just going to the doctor, seeing a specialist, an outpatient surgery, those kinds of things. But then there’s a couple other parts as well, Medicare Part D, like David, or I like to think of it as D for drugs. That’s the easy way to remember that one. That’s going to be the prescription drug coverage. Part C is another way of saying Medicare Advantage. We’ll get into this, I believe in a little bit, but that would be Part C, which combines A, B, and D benefits into one plan.

[0:04:47] TU: Awesome. Timeline for coverage. This is something that I remember learning about this and just having the takeaway of like, this is important. You don’t want to mess up in terms of when you’re selecting coverage, making sure you’re not missing a deadline. What is the timeline for selecting coverage?

[0:05:03] JW: Yup. There’s going to be three main election periods if you want to think of them that way. Three times when you will be signing up for your plan, making decisions on your plan. I will say, there’s a lot of narrative out there that makes this a little scarier than it needs to be. It’s not that intimidating, but the first one is what’s called your initial election period. This is when folks are turning 65, they’re new to Medicare.

Another thing when someone could be using their initial election period is if they’re been on social security disability for 24 months, or if they develop end-stage renal disease or ALS, that’s another time prior to age 65, they can go on Medicare. Let’s use the turning 65, example because that’s the most common. It’s a seven-month window. It starts three months prior to your birth month, runs the month of your birth, and then three months after. A seven-month window when you can sign up. Most folks will use the three months prior and then start their benefits, the month of their birth. That’s the most common.

[0:06:12] TU: That is a pretty – I didn’t actually realize it was that long in terms of the seven months or the three months prior, the month of your birth date, and then the three months after. Then the other piece I’m thinking about here would be the transition or change, right? I had initial coverage I selected here. We’re using the example of 65, but I’m looking at other options in the future in terms of renewals. How does that work timeline-wise?

[0:06:33] JW: Yeah. Great question. That would be what’s referred to as the annual election period or annual enrollment.

[0:06:39] TU: Okay.

[0:06:40] JW: That is a window of opportunity towards the end of the year, getting into it now. October 15th through December 7th of the specific dates. That’s for folks who, yeah, let’s say, for example, they’re 67, they’ve been on Medicare for a couple of years now, but they want to reevaluate and see if the plan that they’re on now is going to be the best one for the coming year. They can evaluate that during the weeks, again, of October 15th through December 7th. Then their change, if they do make a plan change, it would start taking effect on January 1st of the following year.

[0:07:17] TU: Okay. Those are the two main ones I’ve heard you mention so far. So, that initial election and then the annual enrollment process. Anything else important to remember around the timeline for selecting coverage?

[0:07:30] JW: Yeah. There could be a third election period. Just think of them as special election periods. We do run into these. I do run into them every now and then, but if someone moves, for example. Moves out of state maybe or it could even be a move to a different county within the same state, they would qualify for a special election period to make a change. If someone gains or loses Medicaid eligibility, we recently saw a lot of that with the COVID benefits that were extended for folks on Medicaid.

They basically, couldn’t lose their Medicaid eligibility, but that stopped. I believe it was in April of this year. That qualifies for a special election period to make a change or if there’s other things too, like you have a parent who moves into an institution for lack of a better word, where they’re moving into a long-term care facility or a nursing home. That would also qualify as a special election period to make a change outside of annual enrollment. October 15th through December 7th.

[0:08:31] TU: Awesome. With that background information, let’s spend most of our time here talking about evaluating benefit options, what to look for, what to consider. Before we get into five main areas that you’ve seen, five big differences based on your experiences. I think it’s important that we differentiate at least at a high-level Medicare advantage and Medicare supplement plans because when we talk about some of these areas here in just a moment, we’re going to be referring to both of those and the different sides to consider between them. Define those further, for us.

[0:09:00] JW: Yeah. So generally speaking, you have two main options for coverage when you go on to Medicare. I should say this is what most folks do. Most folks will either go with a Medicare Advantage plan or a Medicare supplement. Medicare advantages is much more heavily advertised. Sometimes folks think that’s the only option they have, but they technically don’t. Supplements are an option as well, but there’s going to be five major differences between those two plans that can really impact how you receive your care, what you’re going to pay out of pocket when you use your insurance, how you get your drug coverage, if it includes perks like dental, vision, hearing, all those kinds of things.

Yeah. There are some pretty major differences between those. That’s what I spend most of my time with my clients who are new to Medicare, so they can make an informed decision on what’s best for them.

[0:09:53] TU: Yeah. I remember Josh, you shared with me as we were preparing for this episode. The worksheet that you have of the two sides of the street, right? Choosing a plan. Advantage versus supplement and going through these, which I really like, because I think this can become very overwhelming, either as an individual choosing coverage, helping a family member, helping a patient, especially when so often, as you mentioned, especially on the advantage plan side, there’s just a lot of advertising, right? That’s behind this.

The mailings, the commercials, etc. so really being able to take a step back and say, “What are the options and how can we objectively compare these. What do we need? What do we not need to make an informed decision?” I think is so important, not only financially, but also just have the peace of mind and being able to navigate some of the nuances involved here. Let’s start with those five big differences. Number one, Josh, is Part D in terms of how one receives Part D insurance coverage. Tell us more there.

[0:10:44] JW: Yeah. It’s important to know a lot of people sometimes make an assumption that original Medicare, what we talked about before, Part A and Part B, that includes prescription drug coverage. It actually does not. The only way you can get Part D is through an insurance company. Now, how it would work on either side of the street. Yes, the way I like to describe it. If you go with a Medicare Advantage plan, most of the time, those are going to include prescription drug coverage at no additional cost. If you go with the Medicare Supplement plan, however, it does not include prescription drug coverage or Part D, you have to buy that separately. Advantage is included. Supplement, it’s not included. You have to pick it up separately.

[0:11:27] TU: Number two, it relates to the network here. We’re thinking of options for providers, access to hospitals, something that folks are familiar with from other experiences with health insurance, but what are some of the factors to consider here as relates to network coverage and the two sides of the street?

[0:11:43] JW: Medicare Advantage plans are going to have a network. Meaning there’s a list of specific doctors, hospital systems, specialists that you need to stay within in order to have coverage or to pay the least amount possible. Medicare supplements, one of the big benefits of them is they do not have a network of any kind. You can literally go to any provider in the country, in the whole United States, that takes original Medicare and they have to accept your supplement. It doesn’t matter what insurance company you have. You could be in the Northeast Ohio area like we are and have an insurance company that’s local here and receive care in California and they’ve never heard of your local company, but they have to take it, because it’s a Medicare supplement.

[0:12:32] TU: That network piece, obviously, very important to folks. The third area, which I’m sure is the one we’re often focused on is the cost side of it, the medical bills or the cost-sharing, ultimately what we have to pay out of pocket when using insurance. What are some of the key differences here between the advantage and the supplement?

[0:12:50] JW: With a Medicare Advantage Plan, you will have medical bills along the way as you use your insurance, or just you could say if you use your insurance. By medical bills, I’m referring to deductibles, co-pays, and co-insurance. You may have a deductible. Honestly, most plans I offer, Tim, don’t have a deductible, folks have to reach, but they could.

A co-pay, you know how that works, most likely you pay $25 to your primary care, 40 to a specialist, those kinds of things. Then co-insurance is a percentage, right? You may have to pay 20% for durable medical equipment or 20% for chemo and radiation. The nice thing about Advantage Plans is that they do put a limit on what your medical bills can be. Most folks have this with your current insurance, even if you’re not on Medicare, called an annual maximum out-of-pocket expense.

All of your medical bills for the year can’t exceed your plan’s annual maximum. But know that, again, you will have them along the way, medical bills, that is. Whereas Medicare supplements, they don’t really have any medical bills that you’re going to have to worry about. Okay. Really, the biggest medical bill for the most popular supplement that I write out of my office is the Part B, like boy, deductible. Currently here for 2023. It’s $226, so you pay that for any Part B service. Once that’s paid though, Tim, the medical bills are done for the rest of the year.

[0:14:26] TU: Wow.

[0:14:26] JW: So that $226 deductible is your medical bill and it’s also your annual maximum. If you want to think about it that way.

[0:14:34] TU: Okay. So, very naive on this topic, Josh, but you’re just describing the differences and obviously when you talk about the Supplement plan and the lower amount, what I seem to hear is not insignificant, but a much lower amount on the deductible, less potential out of pocket versus when you reference the Advantage plans more out of pocket. What we tend to think of from our experiences right now for many of us with the insurance. So, is it fair to say that cost-wise monthly premiums, you typically see a vast difference between these two, because of that or is that – it depends?

[0:15:11] JW: No, you’re right. There’s a difference in cost. So, that would be the fourth big difference here between these two. As I’m sure listeners are putting together, if you have to pay medical bills, if you have a network. Well, you’re probably going to be paying less then for your insurance, because you’re subjecting yourselves to these medical bills into this network.

Medicare Advantage is going to be your less expensive route to take. It could even be, and folks may have seen this advertised. You could even see that these Medicare Advantage plans are zero dollars per month. Okay. Those are actually some of the most popular advantage plans.

[0:15:46] TU: Interesting.

[0:15:48] JW: Some of my clients will choose is the zero-dollar premium plan. Okay. Now with supplements, though, these are going to have a monthly cost. There aren’t any zero-dollar Medicare supplements. This currently, I mean, it all really depends on the area that you live in. I just work here in the state of Ohio, but here in Ohio, a good rule of thumb for a turning 65 mail for a Medicare supplement, depending on the plan letter that’s chosen is probably going to be somewhere between $130 to $150 a month for a Medicare supplement. Female would be a little bit lower. Again, that’s a pretty rough estimate, Tim, just depending on the service area that you’re in.

[0:16:37] TU: Yeah. It’s really helpful, though, Josh. I’m thinking about how this integrates back with the financial plan. It’s taking me back to episode 275. Tim and I talked about how to build a retirement paycheck, right? We’ve been accumulating funds. Hopefully, for the majority of our careers. Now we have to be able to replace what was coming from our income through the different retirement vehicles that we’ve built, right? 401Ks, IRAs, maybe we have some HSA funds that can come into play here, as well.

This is important, right? Because if you’re in the plans that you were just referencing on the supplement side, where let’s say you’ve got a monthly premium of $150 a month, and then you know what the deductible is going to be, like we can start to build those numbers into the monthly paycheck that we’re going to be receiving during retirement, essentially paying ourselves or if we’re on an advantage plan, and let’s just say there’s an advantage plan with the example you gave where there’s a zero-dollar premium, but we know what the out of pocket match your limit is, like, okay, we need planning for that, right, or planning for some of the other expected expenses from cost sharing of the healthcare.

You can really start to see how and understanding of the options and the plans and what the impact could be annually, as well as monthly when you talk about something like a monthly premium, could build into the financial plan, build into building that retirement paycheck as we make that transition into that phase.

[0:17:56] JW: Yeah, exactly.

[0:17:58] TU: All right. Number five, Josh. This is one that I didn’t think about that was really interesting when you were talking about this in our preparation for the show. With some of the variances between the plans, when it comes to things like dental, vision, hearing, or the extras, tell us more here.

[0:18:14] JW: When it comes to dental, vision and hearing, this is becoming a much bigger issue, I would say than it used to be. I’ve been doing this for several years now, and back when I started, folks weren’t that concerned about dental, vision, hearing. However, advertisements on TV, the mail that folks are getting that are turning 65 heavily focuses on this side of things. Medicare Advantage plans are going to include dental vision and hearing benefits, as well as other things too, like over-the-counter items, allowances that the plans give people several dollars a month that they are a quarter rather than they can use to buy Tylenol or Advil or Band-Aids and Toothpaste, that kind of stuff.

Advantage plans are going to include those kinds of things. Again, it’s usually at no additional cost. Even a zero-dollar plan would include these things. Whereas Medicare supplements do not include any of these kinds of things, but you can buy them separately, just like you buy the Part D, separately. You can pick up dental vision hearing benefits at an additional cost if you’d like them.

[0:19:17] TU: Josh, before we wrap up by talking about some of the common mistakes that you’re seeing, folks making when it comes to evaluating benefit options and selecting a policy. Summarize here for us the five points that we just talked about as, again, individuals may either be choosing their own policy, working with a family member or working with patients that they can take away this information.

[0:19:36] JW: Yeah. The easy way that I like to describe it is this. If you go with a Medicare Advantage plan, this is going to be your less expensive route to take. It’s going to include Medicare Part D. It’s going to include dental vision hearing. However, you are going to have a network and you are going to have medical bills along the way as you use it. Medicare supplements are your more expensive route to take. They don’t include drug coverage. They don’t include dental, vision, hearing, although you can buy them separately if you’d like. However, you don’t have the medical bills and you don’t have the network to be concerned with.

If you’re a pharmacist out there and you’re trying to quickly explain this to a patient, maybe just go about it that way. Medicare Advantage is less expensive. There’s a network and there’s medical bills. Supplement is more expensive, but it doesn’t have a network and it doesn’t have medical bills.

[0:20:29] TU: Great summary, Josh. I’m curious, like rough numbers. What do you see as like a distribution between these two buckets as you work with those going into Medicare enrollment?

[0:20:39] JW: Yeah. That is a great question. That’s one that’s become very common as my clients are sitting down trying to make a decision on what they want to go with. I’m finding now, Tim, and it didn’t used to be this way, that it is about a 60-40 split. About 60% are going the Advantage plan side and about 40% are going the supplement side. When I first started, it was probably 70-30 the other way or heavily weighted on the supplement.

I think one of the big reasons for this is the marketing. Advantage plans are much more heavily marketed to people who are new to Medicare. I said before, a lot of people think that they are the only option. Not that they’re a bad option, but again, folks are just having much more education, getting much more education about Advantage plans than they are supplements.

[0:21:32] TU: Let’s talk about that marketing because I think that’s one of maybe a little bit too harsh to call it a mistake, but I think the influence of the marketing can be real. I’ve seen many of these commercials, Josh. I think I know the ones you’re referring to and just the impact that whether it’s mail marketing, TV, radio, a combination of can have and sway in someone in one direction or another. Tell us more about that. Even some of the other common mistakes you may see folks making when they’re going through the selection process.

[0:22:03] JW: Yeah. Those commercials are becoming very popular. We’re talking about like the Joe name, this commercials guys that you can’t help but see, especially getting here into the fall into annual enrollment. Those commercials, the mistakes I see people making is buying a plan based off of what they’re seeing just on those commercials alone. If you actually pay attention to one of them, they are referencing primarily the perks of the plans.

The dental, vision, hearing benefits, they may even say things like call and check your zip code, because you could get a plan where you don’t have to pay for your Medicare premium and at all. The plan will pay for it for you. In my opinion, those aren’t the only things you should factor in when you’re buying health insurance. You should factor in other things too, like does your doctor take the plan? That’s a pretty big one.

Yeah, you might have a nice dental benefit, but when you need to go to your primary care physician and they say, “No, we don’t take this.” How valuable is that dental benefit now? Other things, folks don’t necessarily consider, especially on, and we can get into this more if you’d like, but these relatively new to the game Part B, give back plans that pay some or all of your Medicare premium. You got to think from an insurance company’s perspective, if they’re willing to pay your Medicare premium for you, what do you think that’s going to say about the benefits they’re going to provide in the plan?

[0:23:31] TU: Yeah.

[0:23:32] TU: Primarily translates to higher medical bills to you. These are just things that I feel like are important for people to consider that you’re buying a health insurance plan, you want it to be solid when you need it. You don’t necessarily want to buy a plan, because it gives you $100 every quarter and over-the-counter items limit. Those are some of the mistakes I see people making. They buy a plan based off of perks, not necessarily on the day-to-day usage of the plan that could be more important.

[0:24:04] TU: Yeah. Which is, it’s a different form of marketing, right? It’s not necessarily a commercial, but it’s a different form of marketing to hook someone into a policy. That’s a good a good call out. I think both of those Josh, to me highlight the value and you showed me that worksheet, that side-by-side worksheet of, “Hey, we’re looking at supplement plans, we’re looking at advantage plans.” We’re applying somebody’s personal situation. You’re sitting down with them one-on-one, talking through the benefits and the options.

That really brings the life to me, the value that an agent, especially someone specializing in Medicare, such as yourself can be helping, whether it’s the person directly that’s selecting the benefits, whether it’s family members that are involved, or for our pharmacist community, again, especially those working in community practice. I know these questions come up all the time in terms of, “Hey, I’m a patient, I go to the pharmacy, I ask my pharmacist about the policy or what should I be thinking.”

My question here is your work is obviously in Ohio. If we have pharmacists in Northeast Ohio, shout out to Josh, get connected with him for sure as well, but much of our listeners may be across the country. So, words that you would have to share in terms of what are some things that folks can look for in trying to develop a relationship with an agent as a pharmacist or for those that are looking to select a policy for themselves or a family member and partnering with an agent that way, as well.

[0:25:23] JW: Yeah. I mean, first of all, from the pharmacist’s perspective, I do work with several pharmacists and chains and whatnot. I would say from your perspective, don’t feel like you need to be the expert on Medicare Part D, specifically. You can say, “Hey, I don’t know all the answers on what plan you should pick, but here’s a guy you can call, or here’s a girl you can call, they know. They do this for a living.” The other thing too, guys, is it saves you time.

I mean, I see, I’m in and out of pharmacies a lot. I see how busy you are. I can imagine how stressful it is when you have 10 or 20 prescriptions you need to fill and somebody asks to go into the private room and say, “Hey, what prescription drug plan is going to be best for me next year?” It can just take up a lot of a lot of time I would imagine. Again, having an agent you can refer to, to handle those questions for you would save you a lot of time and alleviate that pressure of having to feel like an expert.

[0:26:26] TU: Yeah. Well, this was great, Josh. I really appreciate you coming on the show sharing your expertise. As I mentioned at the beginning, it’s been a long time in the making covering the topic we haven’t done much about before. We will link in the show notes. Josh’s LinkedIn profile, email. If folks have questions, as well as a link to the insurance firm that he works with right now. So, you can check all that information out in the show notes. Josh, thanks so much again for coming on. I really appreciate it.

[0:26:51] JW: Yeah. Thanks for having me, Tim. Go Bills.

[0:26:53] TU: That’s all. This is the year. Let’s do it.

[0:26:55] JW: This is the year, Tim. It’s the year.

[0:26:57] TU: Awesome. Thanks, man.

[0:26:58] JW: Yup.

[0:26:59] TU: Before we wrap up today’s episode of the Your Financial Pharmacists podcast, I want to again thank our sponsor, the American Pharmacists Association. APHA is every pharmacist ally advocating on your behalf for better working conditions, fair PBM practices, and more opportunities for pharmacists to provide care. Make sure to join a bolder APHA to gain premier access to financial educational resources and to receive discounts on YFP products and services. You can join APHA at a 25% discount by visiting pharmacist.com/join and using the coupon code YFP. Again, that’s pharmacist.com forward slash join using the coupon code YFP.

[DISCLAIMER]

[0:27:39] TU: As we conclude this week’s podcast, an important reminder that the content on this show is provided to you for informational purposes only and is not intended to provide and should not be relied on for investment or any other advice. Information in the podcast and corresponding material should not be construed as a solicitation or offer to buy or sell any investment or related financial products. We urge listeners to consult with a financial advisor with respect to any investment.

Furthermore, the information contained in our archived newsletters, blog posts and podcasts is not updated and may not be accurate at the time you listen to it on the podcast. Opinions and analyses expressed herein are solely those of Your Financial Pharmacists, unless otherwise noted, and constitute judgments as of the dates published. Such information may contain forward-looking statements, which are not intended to be guarantees of future events. Actual results could differ materially from those anticipated in the forward-looking statements.

For more information, please visit yourfinancialpharmacist.com/disclaimer. Thank you again for your support of the Your Financial Pharmacist Podcast. Have a great rest of your week.

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