Medicare and Open Enrollment

This is Weekly Dose of Wellness, brought to you by Memorial Care Health System. Here's Deborah Howell.

Deborah Howell (Host): Welcome. As one is reaching Medicare eligibility, you're bound to have a lot of questions. How do you know which Medicare part is right for you? I'm Deborah Howell. And today, we'll be getting educated about the resources to help you determine what is best for you. Our guest is Jose Juarez, a Medicare education specialist at Memorial Care Medical Group. He has many years of experience speaking to seniors and educating them about the basics and intricacies of navigating Medicare, finding the best plan for them, and encouraging them to take advantage of the programs and plans available to them. Welcome, Jose.

Jose Juarez: Hi. Good morning, Deborah and thank you so much for having me on today's program.

Deborah Howell (Host): Oh, believe me, the pleasure is ours. Let's start from square one. What is Medicare and who's eligible?

Jose Juarez: Yeah, so Medicare is a federal health insurance for anyone ages 65 or older. Some people may qualify if they have a disability or conditions if they are younger 65. You need to be a US citizen or a US resident, and you have to work in the US legally for at least 10 years, which is equivalent to 40 credits.

Deborah Howell (Host): Fair enough. And what is the timeframe to apply for Medicare?

Jose Juarez: So on your 65th birthday, you have six months before your birthday, the month of your birthday, or six months after your birthday to apply for Medicare.

Deborah Howell (Host): Also fair. Okay. Now, what are the different parts of Medicare and the cost associated with them? Because that's where people get little tripped up and confused.

Jose Juarez: Yeah, that's correct. So a lot of people think, you know, Medicare is free because they paid into the system, right? Unfortunately, it does not work like that. Part A is your hospitals. Part A is a zero monthly premium. You did pay into the system, so that's the reason why it's a zero monthly premium. Your part B is your doctors. Part B comes with a monthly premium. And this monthly premium is based on your income, right? And towards the end of the podcast, I will include some websites where you can look and see what your income level will be, which will reflect your monthly premium. But for the average, it's about $170 for 2022. There are rumors for next year in 2023 that it will go down to $164.90. That's $164 and 90 cents per month. And it is deducted from your Social Security automatically, so it makes it easy.

Deborah Howell (Host): Oh, that's interesting.

Jose Juarez: Yeah, it makes it easier for the seniors not to remember to pay another bill. And then, you have your Part D, your drug coverage. These are standalone drug plans you can purchase. And also, Part C, which I'll explain a little further down the presentation.

Deborah Howell (Host): Can you tell me the difference between a Medicare Advantage versus a Medicare Supplement plan and what's the cost for both?

Jose Juarez: Absolutely. And that's a great question. I think this is the biggest concern, you know, with seniors. So your Medicare Advantage Plan, these are your HMOs, right? There are no additional monthly premiums as long as you pay your Part B premium. Your drug plan is included at no extra cost. All the insurance companies, especially in California, they're very competitive. They have additional benefits like dental, vision, hearing aids, over-the-counter benefit, transportation, free gym membership, worldwide coverage, right? Again, these are your HMOs. So in case, you know, you're going to have a primary care doctor assigned to you, and if you wish to see a specialist, you have to go see your primary and get a referral, okay?

Your Medicare Supplement plans, these are similar to a PPO plan. You do have the flexibility to see any primary care doctor, any specialist. You don't need a referral. I don't want to say a downside to this, but to have the flexibility, obviously you're going to pay a little more, right? You'll have your Part B premium, your supplemental premium, and you have to go out and get a standalone drug plan premium, which will vary depending on the medications you take. Your Medicare Supplement premium goes up every year, so there is no caps.

Deborah Howell (Host): I see. Okay. I'm writing stuff down because this is very, very pertinent to a lot of people in my life. So let's say I currently have Medi-Cal and I'm turning 65 soon, do I need both Medicare and Medi-Cal?

Jose Juarez: Yes, you do. You do have to apply for Medicare, otherwise you will get penalized and that penalty will never go away. And actually, if you have a hundred percent of Medi-Cal, you get the best of both worlds, right? Medi-Cal will help you pay for your Part B premium and any additional cost that you have related to your healthcare.

Deborah Howell (Host): Now, say I'm Medicare-eligible and have insurance through my employer, do I need to even apply for Medicare?

Jose Juarez: No, you don't. As long as you have insurance through your employer, you don't have to apply for Medicare. I do suggest doing a plan comparison, compare your monthly premium that you're currently paying with your employer, compare those benefits, right? Because the maximum out of pockets are very different versus the Medicare ones and the ones that your employers have. So, I would definitely do a plan comparison and you never know, maybe you'll be saving a little bit of money.

Deborah Howell (Host): Sure. And then, also the same would apply for people who have insurance through their union.

Jose Juarez: That's correct.

Deborah Howell (Host): Now, I'm Medicare-eligible, but my spouse is younger. What options do we have?

Jose Juarez: Yeah, that's a great question too, Deborah. I get asked this all the time. Unfortunately, the moment you leave your employer's insurance and go into Medicare, your spouse will lose her or his health insurance. There are some exceptions, some employers that allow the employee to keep their spouse under the plan. Obviously, you have to continue paying the monthly premium, but you are going to have to find a health plan for your spouse or even dependents, right? We have kids that going to college, and there's several options out there like Covered California, Oscar Insurance. So there various, you know, insurance companies out there that you would have to go into.

Deborah Howell (Host): Yeah, that is a biggie. What's the Medicare Annual Election Period? And how can seniors change their plan or add to their plan if they want to do that during this time?

Jose Juarez: The annual election period is very important. I can't stress enough to tell people that these dates are very important, and that's from October 15th through December 7th. And this is a time where you can do a plan comparison, check if there's any changes on your current health plan, because this is a timeframe where you can change, right? I know throughout the year you start off the year very healthy, not taking any prescriptions and, God forbid, you fall or something happens to you and all of a sudden you're going to have a bunch of expenses, all because you didn't do a plan comparison. And I highly suggest doing one every year.

Deborah Howell (Host): That's good advice. And what happens if a person does miss the annual election period?

Jose Juarez: Yeah, so this is very scary too because if you do miss your enrollment period, you do have a penalty. There are some exceptions like anything. But if you do miss your enrollment period to apply for Medicare, you can apply on January 1st, right? You can't go over 12 months because then you will get penalized.

Deborah Howell (Host): Well that's good. That's a little fail safe for people. January 1st, very important date in case you miss it. Such important information, Jose, and I know you're gonna give us some resources shortly. But is there anything else you'd like to add to our conversation first?

Jose Juarez: Yes. you know, I can't stress enough. October 15th through December 7th, this is a time where you have, you know, the opportunity to do a plan comparison, look to see what plans are out there, any changes, prescriptions. For 2023, there's a lot of great plans coming out. So please reach out to your, you know, independent agent if you have one. If not, I'll be more than happy to refer you to one. And as far as those additional resources, you know, you can go onto our website, memorialcare.org. You can also go onto medicare.gov, cms.gov, ssa.gov, or you can also call me on my cell phone at 714-640-7158. Again, the number is 714-640-7158. If you have any questions, you need forms, pretty much any information you need, please don't hesitate and give me a call.

Deborah Howell (Host): Information is power, right.

Jose Juarez: That's correct.

Deborah Howell (Host): Okay. Oh my goodness. Thank you so much for all those resources and even including your own personal cell phone. Incredible. Thank you, Jose, for your time and expertise today.

Jose Juarez: Thank you, Deborah, and I appreciate the time.

And for more information or to listen to a podcast of this show, please visit memorialcare.org. That's memorialcare.org. That's all. For this time. I'm Deborah Howell. Have yourself a terrific day.