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Now or Never: Long-Term Care Strategy is a podcast for all those seeking answers and solutions in the long-term care space. Too often we don’t fully understand the necessity of care until it’s too late. This podcast is designed to create solutions, start conversations and bring awareness to the industry that will inevitably impact all Americans.
Christian Worstell: If you're on
Medicare, obviously you're
getting older every year. The
key is really making sure that
your plan aligns with your
needs. And I think it's
important to kind of every fall
do kind of an audit of your
health and see where you're at
and examine your plan and see if
that plan still aligns with
those needs.
Caroline Moore: Welcome to Now
or Never Long-Term Care Strategy
with Kosta Yepifantsev a podcast
for all those seeking answers
and solutions in the long term
care space. This podcast is
designed to create resources,
start conversations and bring
awareness to the industry that
will inevitably impact all
Americans. Here's your host
Kosta Yepifantsev.
Kosta Yepifantsev: Hey, y'all,
it's Kosta. Today, I'm here with
my guest Christian Worstell
Senior Medicare and health
insurance educator with health
advisor.com. As a licensed
health insurance agent and
industry advocate. Christian has
helped 1000s of Americans better
understand their health
insurance and Medicare coverage
featured everywhere from Forbes
MarketWatch WebMD, and Yahoo
Finance Christian primary goal
is to provide accessible
information on health care
coverage, limiting out of pocket
Medicare spending, and how to
access quality medical care,
Christian to start the episode,
will you explain to us what the
Medicare Annual Enrollment
period is, and why it's so
important for beneficiaries to
be aware of it?
Christian Worstell: Yeah, first
of all, thanks for having me on.
Good to talk to you about this
today. AEP Medicare annual
enrollment period. For most
people, it's the only time of
year that you can make changes
to your private Medicare
coverage. So we're talking
medicare advantage and medicare
part d. When you first become
eligible for Medicare, you will
be able to enroll in private
Medicare, you'll have a seven
month it's called an initial
enrollment period or IEP. If you
don't sign up, then you will
have to wait to until the annual
enrollment period in the fall.
Or if you are in a plan that
you're maybe not fully satisfied
with. And you want to explore
other options other plans. AEP
is your chance to switch from
one plan to a different one. And
the reason it's important is
because, again, for most people,
this is their only opportunity
during the year to do this. So
once you're committed to a plan,
you're probably not going to be
able to switch to a new one
until the following AEP the
following year. So you might be
stuck with a plan that you don't
really love for a year. It's
also important, if you know you
might run into a coverage gap. A
lot of Medicare Advantage plans
will include things like routine
dental coverage. Well, if you
don't get into a plan that has
routine dental coverage, then
you need to figure out what
you're going to do about your
dental coverage for the next
year. Are you going to pay for
it? How are you going to buy a
standalone dental plan you'll
need to kind of patch things up
there. So it's really just you
know, making sure that you're
setting yourself up for success
for the next year until the next
AV.
Kosta Yepifantsev: Let me let me
dig a little deeper. Give me
some background about the
difference between IEP and AEP
and you touched on it a little
bit, but I just want to just to
put it in layman's terms, what's
the difference between the
initial and the annual
Christian Worstell: Yep,
initial, you turn 65. And you're
gonna begin a seven month
enrollment period, you have
seven months to enroll in
coverage, Medicare Advantage
Medicare Part D Original
Medicare, and then annual
enrollment period. It happens
every year, October 15 to
December 7, so just a little
less than two months, and those
dates don't change. So no matter
what day of the week, you know,
it might start on a Saturday, it
might start on Wednesday,
October 15. It starts December
7, it ends so you only ever ever
get one initial enrollment
period. But you'll get an annual
enrollment period every year. So
you might get 25 Annual
Enrollment Periods but you only
get that one initial
Kosta Yepifantsev: period. What
what happens if you turn 65 And
you just don't enroll into into
Medicare. What happens if you
miss the deadline for the
initial enrollment period? But I
also want to know what happens
if you miss the deadline for the
annual enrollment period that
October to December period.
Yeah, so
Christian Worstell: most parts
of Medicare do have Late
Enrollment penalties. So if you
do not sign up when you're
eligible, and that initial
enrollment period closes, at
some point down the road, when
you do get it together and sign
up, you will probably pay higher
premiums. There are some
exceptions, but most people are
going to be subjected to those
late enrollment periods or
penalties. And the penalties are
not necessarily just a one time
thing, it's actually an increase
in your premium it might be, you
know, 3% added to your premium
for every 12 month period that
you didn't enroll or something
like that. So you're going to be
paying for that late enrollment,
every month, when you make that
premium payment. That's really
the biggest risk. The other
risk, obviously, is just going
without health insurance or
going without adequate health
insurance during that time until
you change and sign up.
Kosta Yepifantsev: And so with
regards to the Annual Enrollment
period, the consequences of
missing that deadline is
obviously if you already have
Medicare, like traditional
Medicare, or even Medicare
Advantage, for that matter, you
just won't be able to make any
changes to plan if that's
necessary. Right?
Christian Worstell: Correct.
Yeah, there are certain there's
what's called a special
enrollment period. And not to
try to get too far into the
weeds here. But there are people
that might qualify for a special
enrollment period throughout the
year based on certain
circumstances that happen. But
you're right, for most people,
its annual enrollment period, or
bust, and your that's your, you
know, seven week period eight
week period that you get to do
every fall. And if you don't do
it, then you're having to wait
until the next one. So that's
why we really stressed the
importance of you got to take
action now. Because it's now now
until next year, I should say,
Kosta Yepifantsev: yeah, it's
now or never, it's a good point.
So, I do want to say, I want one
more follow up question. And
then we're going to talk about
Medicare specifics about how
it's changing. And obviously,
you know, kind of what's new and
coming down the pike. Why is
there a penalty? What is what is
it about not taking Medicare,
that the federal government or
or whatever entity Centers for
Medicare and Medicaid said they
want everybody to enroll in
Medicare? I was curious if you
knew why there's an actual
penalty for not taking Medicare
after 65. I think it
Christian Worstell: probably
boils down to keeping costs
lower for everyone across the
board, because it wasn't a late
enrollment penalty. If you turn
65, and you say, Hey, I'm
healthy, I'm still pretty spry,
I could probably put it off for
a couple of years, well, then
you're not paying into the
system. Right? And then you get
into that situation where you
know, only the sick people are
enrolled in Medicare and the
costs are higher. So I think
it's kind of maybe a similar
strategy to, you know, the ACA
and mandaps. Having penalties
for that. It's just an effort to
get everyone contributing to
keep costs lower across the
board.
Kosta Yepifantsev: Absolutely.
All right. So let's get into it.
How is Medicare changing? And
what's new for 2024? Yeah, so
Christian Worstell: every year,
there are some changes to
Medicare. Some years, those
changes are bigger than others.
Okay, over the last few years,
due largely because of COVID.
There were a lot of changes, you
know, they introduced some more
telehealth coverage and things
like that. I expect 2024 to be
relatively quiet when it comes
to changes or things that are
new. As AEP inches closer, we
may learn about some of the more
new or changed Medicare
Advantage benefits. A lot of
times it's right up until AEP
when we actually find out about
the some of these changes once
they're finalized and formally
announced. But one thing you can
expect premiums and deductibles
for both traditional or Original
Medicare and private Medicare
typically change every year.
There has not been a formal
announcement yet but it should
be coming probably any day now.
Usually by the end of September.
About the Medicare Part B
premiums. The projections are
showing it to go up about $10 a
month, and those projections are
usually pretty ballpark
accurate. So we can expect that
it actually went down last year,
which is why the models are
showing probably tick up this
year. Yeah. Part Willie? Oh, I'm
sorry. Good.
Kosta Yepifantsev: I was just
gonna say, will there be any I
know, a few years back, they
added a kind of like a
homemaker, non medical type of
component to some Medicare
Advantage plans. Has there been
any news or appetite, I guess,
for traditional Medicare to take
on that same kind of benefit?
Christian Worstell: I think
there is an appetite. It's not
something that we're going to
see in 2004. But it wouldn't
shock me if that was kind of the
next thing coming. You know,
sometimes, things often get
introduced to private Medicare,
first Medicare Advantage, and
then they might get adopted by
Original Medicare. One example
of that is acupuncture. A few
years ago, acupuncture became
approved for Medicare Advantage
plans, what you know, under
certain circumstances, for lower
back pain, stuff like Cher, and
it was offered exclusively in
Medicare Advantage for a couple
of years. And then Original
Medicare said, Hey, this is
good. We want to adopt this. So
now you can actually get it with
Medicare Part B. The, you know,
the aging in place or homemaker,
you know, those kinds of
services that you speak of, a
lot of them are available today
and Medicare Advantage plans and
have been for a few years. It
wouldn't shock me if that one
day was adopted by Original
Medicare. But yeah, no news on
that, as of
Kosta Yepifantsev: are you
excited about the negotiations
for drug pricing? I know it's
not going to happen, you know,
it's not going to go into effect
for a number of years. But how
is that going to change Part D?
Christian Worstell: Yeah, and in
fact, that's kind of a good
jumping off point, because a lot
of the changes for 2024 are
actually happening in part d. So
for one, the models are showing
that the average monthly premium
will probably tick down just
slightly. There's also the long
story short part D benefits are
going to actually improve in
2024. So some of the coinsurance
payments that you have to make
for drugs are going to disappear
during certain coverage phases.
The out of pocket spending limit
for brand name, drugs looks like
it's going to be lowered.
There's a coverage gap that
looks like it's going to be
eliminated. And it also looks
like it's going to be easier for
people to qualify for cost
assistance. So yeah, I think the
the ability to negotiate drug
prices is a real game changer,
because that puts, you know, it
kind of shifts the balance of
power from you know, the drug
manufacturers to, you know,
consumers a little bit.
Kosta Yepifantsev: I mean, it
would be great if they could get
a actual drug that works for
Alzheimer's would you want to
talk about and I'm sure Medicare
would be more than happy to, to
not negotiate for that pricing,
because that is something that
is obviously affecting a lot of
us so
Christian Worstell: so that's
interesting. You say that
because the big reason why the
Part B premium is projected to
go up a little bit in 2024 Is
that part B is now going to
offer coverage of an Alzheimer's
drug that has performed very
well in clinical trials. Wow,
that do not have the name of it
in front of me.
Kosta Yepifantsev: It's is it
add a hell? I think that is it.
I think I've been hearing it
over Yeah. And and so I'm
excited to see that
Christian Worstell: it's
performed well, they're they're
obviously optimistic enough
about it to go ahead and begin
covered covering it. And as you
know, you know, he's Alzheimer's
drugs are so expensive that if
Original Medicare is going to
cover it, they're gonna have to
raise the premiums, because
it's, we're not at that place
yet where those types of drugs
are just easily affordable. So
yeah.
Kosta Yepifantsev: And one thing
I wanted to ask you as a segue,
you know, there is Medicare
Advantage plans are becoming
more and more part of popular,
so like private Medicare plans,
essentially. And I think it's
something along the lines of
like 30% or 40% of Medicare
enrollees select Medicare
Advantage. It's actually not
50%. Now it's 50%. Okay, great.
So like, obviously there's a
shift to where instead of it
being the red, white and blue
card, traditional Medicare,
it's, you know, Cigna or or
Aetna or you know WellCare,
whatever it might be wellspring.
But I want to ask specifically
about the beneficiaries. What
steps should Medicare
beneficiaries take to assess
whether their current plan still
meets their needs?
Christian Worstell: Yeah,
there's a few things. I think
the first one is, have your
healthcare needs changed,
because in 2023, your healthcare
needs were, you know, x, right.
But in 2024, they might be
different. I mean, we're, you
know, if you're on Medicare,
obviously, you're getting older
every year, your health care
needs might change, you might
develop different, you know,
conditions. And the key is
really making sure that your
plan aligns with your needs. And
I think it's important to kind
of every fall, do kind of an
audit of your health and see
where you're at and examine your
plan and see if that plan still
aligns with those needs. I think
another thing is, is your
doctor, still part of your plan
network, because doctors can
leave a plan network every year.
So your favorite doctor that
you've been seeing for 20 years,
you have a great relationship
with them great rapport. They've
accepted your plan for all these
years, and all of a sudden next
year. They're no longer
accepting your insurance they've
was, you know, Aetna or
whatever.
Kosta Yepifantsev: Yeah. But
like Does that happen with
traditional Medicare, or is that
only like a dynamic that's
specific to the private Medicare
sector
Christian Worstell: is certainly
more specific to the private
sector. Something that you like
95% Plus, of all healthcare
providers accept Original
Medicare. However, the
percentage of them that are
accepting new Medicare patients
is a little bit lower, probably
closer like 85%. Interesting. So
your doctor might accept
Medicare, but they may not
accept new Medicare patients at
this time. So it does play into
that a little bit.
Kosta Yepifantsev: But we could
have a conversation about that.
Absolutely, yeah. Christian,
what do you think is the most
common mistake people make when
it comes to Medicare?
Christian Worstell: Yeah, I
mean, we talked about waiting
too long to sign up missing that
initial enrollment period or
missing, you know, the annual
enrollment period, facing late
enrollment, penalties facing
coverage gaps, stuff like that.
We talked about, you know,
signing up for a plan that
includes your favorite Doctor, I
see people that sign up for Part
D plans that don't cover their
drugs that they need. Or people
that signing up for plans that
may not cover their specific
health care needs. You know, if
you wear glasses, you probably
want a health insurance plan
that gives you you know, annual
exams and allowance for, you
know, Vision Insurance,
essentially.
Kosta Yepifantsev: Yeah,
Christian Worstell: you know,
you know, make sure that it
lines up. I think just not not
taking the time to shop around
and compare plans, you know,
most people have, it's not
uncommon for people to have
their choice of like 20,
different Medicare Advantage
plans that are sold in their
area. I mean, you have all most
people have a lot of options at
their disposal, take the time to
sit down and compare them.
Invest 30 minutes of your day,
to set yourself up for the next
year of having good, affordable
coverage. And then the last
thing I would say is people that
try to navigate the process
alone, rather than working with
an agent, because an agent can
just gather up all the plans
that are available in your area,
help you comb through them help
you compare them. If you're
trying to go about it alone,
you're trying to pull in all of
those individual pieces yourself
and visit all of the different
carrier websites, and it gets
gets pretty calculated.
Kosta Yepifantsev: Where do they
find their local Medicare
specialized agent?
Christian Worstell: Yeah, so I
mean, Medicare advantage.com
Okay. It's one of the largest
sellers of Medicare Advantage
and Medicare Part D coverage. I
believe it's available in all 50
states. There are something like
1500 agents. They specialize in
Medicare You know, so a lot of
other agents are selling regular
health insurance or they're
selling life insurance but
Medicare advantage.com They only
sell private Medicare insurance.
That's what they do. All day
every day.
Kosta Yepifantsev: Yeah. I'm,
and I've heard I've heard so
many stories of people, and I'm
so glad that we're talking about
this, of say, for example, you
know, you're watching TV and a
commercial pops by and it's
called this number, you know,
and it looks like a red, white
and blue Medicare card and they
call the number, and the person
on the phone essentially, you
know, has gets them to switch to
their Medicare Advantage plan
with whatever insurance company,
they get paid a premium or a
fee. And the insurance that they
get, does not meet the needs and
expectations of the individual.
And they have to wait until the
next, you know, enrollment
period to switch back to, to
what have you. And so I think
I'm very glad that we are
putting together a process in a
pipeline for people to actually
reach out to the, to the correct
individuals who have their their
best interests in mind. So
Exactly, yeah, let's let's talk
about the process of switching
from one plan to another plan.
Is it a complicated process,
Christian Worstell: it's really
not, and especially if you work
with an agent. So if you get on
the phone with a licensed
insurance agent, especially one
that just specializes in
Medicare, they can actually
disenroll you from your old
plan, get you enrolled in your
new plan, during the same phone
call, you do not have to have
any contact with your previous
carrier, they will handle all of
that behind the scenes. So no,
it is not complicated. Really
the most complicated process is
just the shopping and comparing
part and choosing from your many
options. And once you zero in on
the plan that's best for you.
It's actually really simple.
It's it's pretty quick and
painless, to be honest. So no,
not complicated at all.
Kosta Yepifantsev: In your
opinion, aside from the ones
that we've already mentioned,
what are the most important
factor beneficiaries should
consider when choosing a new
Medicare plan?
Christian Worstell: Yeah, I
think the whole HMO versus PPO
plan is pretty important. I
think, you know, Medicare is not
radically different from you
know, employer based coverage,
or most people that are
transitioning to Medicare,
they've probably been on health
insurance for 30 or 40 years.
And a lot of those routes are
still there, like HMO or PPO. So
do you want an HMO plan? That's
a little bit more of a team
oriented approach where you
know, your team of doctors are
referring you within the
network? Or do you like the PPO
approach where you have maybe a
little bit more personal freedom
over your your healthcare
choices, and you can go outside
of a network? I think that's
important for people and and by
the time they get to Medicare,
they've probably figured out if
they're an HMO person or a PPO
person. I also think, you know,
I asked people, How do you like
to spend? Do you want to pay
higher monthly premiums up
front, in exchange for lower
deductibles and lower CO
payments when you use the
insurance? Or do you want to pay
lower premiums upfront and then
reach a little bit deeper into
your pocket when you use the
insurance for higher deductibles
and, and higher CO payments or
coinsurance? There's no really
right or wrong universal answer
there. Everybody likes to spend
their money differently. And I
think he just has to have to ask
yourself, you know, how do I
want to spend my money? I think
that's, that's a really
important thing that I think
gets overlooked a little bit too
much by people.
Kosta Yepifantsev: We always
like to end the show with a call
to action. For anyone who wants
help with this process. What's
your advice on finding a
knowledgeable and licensed
insurance agent who specializes
in Medicare?
Christian Worstell: Yeah, so I
mentioned it previously, but
Medicare advantage.com is the
one that I always recommend to
people first. Like I said,
they're one of the largest
sellers, they specialize in it,
you know, over 1000 agents,
they're all US based agents.
They even have bilingual agents
for those that need it. And it
really is the best way they're
all licensed, you know, highly
trained, experienced, but you
know, they can disenroll you
from your previous plan and
enroll you in a new one. They
can also just sit there and
answer your questions. And you
know, there's a lot of things
that you may not understand
about Medicare. They'll sit
there and help you, you know,
they'll talk you through you
know, how this works, what these
benefits mean, you know, you
know, come through all of those,
you know, terms and conditions
and fine print. So they're kind
of part advisor part agent. They
can help sell Will you a plan
and get you enrolled but they
can also just help you
understand it better and kind of
advise you on you know this plan
versus that plan etc so let's
Medicare advantage.com Is the
always kind of the place to
Caroline Moore: Thank you for
joining us on this episode of
Now or Never Long-Term Care
Strategy with Kosta
Yepifantsev.If you enjoyed
listening and you wanna hear
more make sure you subscribe on
Apple podcast Spotify or
wherever you find your
Podcasts,leave us a review or
better yet share this episode
with a friend. Today’s episode
was written and produced by
Morgan Franklin. Want to find
out more about Kosta? Visit us
at kostayepifantsev.com