Episode Transcript
Speaker 0 00:00:00 Yeah, that's, so one good way to confuse people is throw terms they don't know. And, and Medicare does a good job of this by saying, a, why don't they just say inpatient care, B, why not outpatient? And the problem is that there's also a Medicare supplement, part A, a Medicare supplement, part B, a Medicare supplement Part D, that have nothing to do with, you know, Medicare.
Speaker 2 00:00:27 As our parents grow older, it can be difficult to guide them through their golden years, while still respecting their autonomy and fitting it into our already complex lives. Welcome to the Parent Projects Podcast, where our guests share practical wisdom to tackle the issues that impact adult children of aging parents. I'm Tony Sievers. Thanks for joining us today.
Speaker 3 00:00:51 Welcome. This week, uh, we're gonna welcome in Matthew Clawson, uh, with Medigap Seminars. Matthew is considered a leading, uh, national expert in Medicare. He's gonna be able to break down for you ways to identify where you guys are at, what might, what your options might look like, what's coming at you, some places to go. He's a distinguished member, uh, also with the Forbes Business Councils. Uh, he's, we've invited him up here to take that simple message that he uses with his seminars and help us break down our pair projects today. Matthew, thanks for joining us in studio.
Speaker 0 00:01:24 Oh, thank you Tony. I appreciate being here.
Speaker 3 00:01:27 Oh, we definitely love having an expertise like yours around, 'cause this is, this can be an, uh, you know, some people say drinking from the fire hose. This is like drinking from the hydrant most of the time. <laugh> as, uh, as we jump into this in the front end. I mean, this is, uh, this is not something most of us choose to want to spend a lot of time with every day.
Speaker 0 00:01:49 Oh. How did,
Speaker 3 00:01:50 How did you come to, to, to dedicate your life to it, to be as awesome as you are?
Speaker 0 00:01:55 Well, so I, you know, it's been in the financial services business since 1984 and, uh, uh, interesting As the very first company I started working with, uh, Ferris back in Washington, DC had a claim to fame of giving seminars. They were the first investment group to give seminars. They'd go off to the Peck stores and other stores and give seminars. So my entire training process in that was six months of how to give a good presentation, uh, in addition to others. But it was six months of presentation skills. So that's was the first part of my life. And, um, back in 2015, I kind of semi-retired and was trying to figure out what to do. And I had run through circumstances and, you know, both my parents and friends and others who were just people being extremely confused about Medicare. And I, I kind of looked at the industry and I said, yeah, I can, I can do this.
Speaker 0 00:02:46 I just created seminars and I started doing seminars to teach people Medicare. And one thing led to another. And now we are one of the largest Medicare boutique specialty, uh, agencies in the country. Uh, and, you know, it's, it's important stuff because it, it gets confusing and people are often, they're stressed, et cetera. And so we take 'em through a process and our motto is to help them make an informed decision and just walk 'em through the process of what Medicare is, where the pitfalls, what's the pros and cons of the choices that you have to make. And, uh, it eases their stress and helps them to relax, make a good decision, and be comfortable and confident in that decision.
Speaker 3 00:03:31 Well, in that, that approach that you use with the seminars is a mm-hmm. <affirmative> very, um, it's a very soft approach at that. It's a very consultative approach, which is in, in a time in which information's bombarding you in sales, everybody's trying to really sell you something. Yeah. It's nice sometimes just to have that approach where they just want to educate you <laugh> so you can get your witts about you and make a, make a good decision that's in the best interest of you. Do you find that, that, that, that, you know, who, who, who's the typical audience that that's, that's reaching out? Is it, is it usually mom and dad? Is it often family members with a parent project? What, what does that usually? Well,
Speaker 0 00:04:08 You know, the most often it is people who are turning 65 or turning 67 in retiring, however it is. And they're trying to make sure they make, uh, the right decision. Uh, but yes, we do get, uh, a lot of the adult children who are, you know, they're trying to help their parent out of necessity or desire because it's extremely confusing. And, you know, there, there was a time, it's getting less and less every year, but there was, you know, the time that, that, that a lot of people weren't as computer literate either. And they're stumbling over, you know, how, how do I learn this stuff that's all online and I'm getting lost and confused, et cetera. And of course, they're having to deal with, um, people to turn 65 and know that starting about six to eight months before your birthday, you're gonna start receiving phone calls, cold calls, mail.
Speaker 0 00:04:58 I've, I've seen pictures of people's piles of mail. They don't even know where to start with. That's just amazing. You know, that, that, that they go through. So, you know, that's the, the, that whole process of people that turn up to us are people who wanna learn Medicare and they have to learn Medicare to either for themselves or to help a loved one. And, you know, it's what we do. We help them make an informed decision and help take the stress away. It's, it's, that's why, um, you talk about sales stuff, we don't, I don't even hire salespeople. <laugh>. I I mean, none of my people are, have a sales background. They're all people who have something that happened in their life to a family member that makes them want to help others. It gives them the empathy and the compassion. Yeah. Those, that's how we approach this. Uh, that's what we do. And, and people know it. And that's why there's, well, you know, we get a lot of, of gratitude, uh, on online from, from how we approach all of this.
Speaker 3 00:05:54 And I've, I've loved learning that about your business as well. 'cause, 'cause it's the same approach that we work through and we, we, we call it attraction over promotion. Uh, and just from a core of, of when we're out there helping someone, you know, when, when you're looking, when you have an issue like Medicare, that is, it's, it's ongoing. It, it's not one of, you know, there are many tasks, there are many projects that, or parts of our project that get kind of compartmentalized or have a season to up and down. You've got, this is one that, that goes, yeah. I mean, it just continues to go, it continues to evolve mm-hmm. <affirmative> and then, and then it itself is kind of shifting. We'll talk about that. Is there, it it, a baseline is when you're starting into this, is, is there a big difference if you're looking at this from the age, uh, if you're learning about this, of trying to make a decision for yourself or learning about this to make a decision, or to not to make a decision, but to give advice and to an older family member. Is there, is there anything, or generally is most of the knowledge you're gonna be learning about applicable off of both sides to both age boots?
Speaker 0 00:06:59 Well, yeah. The, the knowledge is applicable to both sides. The difference is that when a person is turning 65, they have a clean slate. No matter what their health have been previously, they can, they can make any of the choices that they have available to them. Oftentimes when we are dealing with the, you know, the, the adult child who's trying to help their parent, their parent is, you know, in the seventies, not just turning 65 and, uh, or even older. And they, some of their, depending on what they did, if they made the wrong choice at first, uh, they, they may have limited options. Yeah. And, you know, we still have to work with those limited options and there's still something we can do. But, so yes, it can be very different if the parent has gone in one direction versus the other. Uh, the very first question though, that we will get from, you know, the adult child's trying to help with stepping in, is they're trying to figure out what it is their parent has.
Speaker 0 00:07:56 Right? They, they have no idea. And a lot of times the parent doesn't know either. And so there's a, you know, process we do, you know, it's, it's said, listen first, take a look at their cards. You know, if they're showing you a card with an insurance company name on it, and this is what they show the doctor and it says an H M O or a P P O, then they have what we refer to as Medicare Advantage plans. If they're showing you their red, white, and blue Medicare card and maybe a prescription drug card, then they have what we refer to as original Medicare and two completely different, you know, they, they both have the word Medicare in 'em, but they're completely different, um, plans, insurances that, that, that have different limitations and options to them. And of course, the other, the next step is if even that becomes confusing, they, if they should have a, my medicare.gov account that's free, and everybody that's on Medicare can sign up for one, that'll tell you all of that, plus have all of the records of their prescriptions, their doctor visits, everything online, and, or they can call Medicare, call 1-800-MEDICARE and speak to them.
Speaker 0 00:09:05 We always say, if you don't have a, you know, a power of attorney with a, with a health care clause in it, then you'll typically have to call with your parent. And then Medicare will, you know, talk to the parent and say, is it okay for me to talk to this person? They get verbal approval and then you can find out what they have. And that's really the first step in, in helping a parent, you know, what is it that they have?
Speaker 3 00:09:29 And, and that is, is a brilliant first jump in from all of that. So, uh, if I, if I captured off of that, that is those ID cards and mm-hmm. <affirmative>, that red white, I've seen, we've seen those red, white and blue ones, these other supplements. I'm hoping that we'll at least maybe get a quick synopsis of A, B, C, D, E, F G H. Yep. In, but like, just of a quick understanding of where those might fit in when we come back from that, um, that my medicare.gov, the, um, the 800 Medicare mm-hmm. <affirmative>, um, essentially it's that, that's assessment. Those become the source information and those best places to start. Correct. Um, okay. Awesome. I love that. We're gonna, we're gonna take a knee, we're gonna take our first break off of that. When we come back, we're gonna learn, maybe dig down, go take a look for one of those cards, maybe pause the episode.
Speaker 3 00:10:17 Those are the things that you're looking for to work off of that. When we come back, uh, we're going to continue this conversation with Matthew, Matthew Clawson as we work through, um, how we can be making Medicare digestible, stay tuned for Parent Project podcast. We'll be back right after this. And welcome back, uh, Matthew Clawson today, uh, in from Medigap seminars, helping us, uh, to get through this, making Medicare digestible, Matthew. Uh, so once we have, uh, once we've, we've been able to grab from the source mm-hmm. <affirmative> an understanding of those ID cards. Uh, we've been on my medicare.gov, we've called the phone number. We've been able to pull that information together. Uh, now I understand I might have an A or B, I'm still trying to figure out exactly what those are. Okay. Can you, at a high level, can you walk us down the alphabet of what the government is throwing at us, please?
Speaker 0 00:11:13 Sure. So the, um, the two different areas that, you know, a person can have is if they're showing you again, a, uh, an insurance company card, you find out they have, is called a Medicare Advantage plan. We'll start with that. The Medicare Advantage plans actually replace Medicare. They are the privatized version of Medicare. So, you know, some people said, you can throw away your red, white, and blue card. Please never do that. But you don't need that. You're not gonna use that anymore. You're gonna have, uh, an insurance card from an insurance company, and, and you'll use that when you go to the doctor. Now, there's some things that, that you should know if you're trying to actually work with it or, or help with it. It, you know, one is that these are are plans that have to cover all of the same benefit categories as original Medicare, even though it's privatized, it's not Medicare. They have to have all the benefit categories. It's not all the same benefits that is often misunderstood. Um, but the, you know, the, the same benefit categories, then these plans change. Can I, can
Speaker 3 00:12:16 I ask you just a clarification? When you say that, when you say not all the same benefits, uh, you mean it, it's, it's within the category. It may or may not cover, um, you know, what one particular type of a procedure, but it's got a category of those procedures. So you're, you're not just talking about, um, about coverage limits of like cost, how much money, but, or what is it?
Speaker 0 00:12:39 Well, it is, it's both. So you're okay with a Medicare Advantage plan. Your, your healthcare's controlled by an insurance company who's trying to make money. Okay? So they get to set some limits on your care. Now, I, I like to use the example of, um, if you, let's say you, you need a, a joint replacement, and a doctor says, I need a joint. You need a joint replacement. Well, with a Medicare Advantage plan, you first have to, the doctor submits that request to the insurance company, and they can come back first and say, well, instead of doing an operation, give them physical therapy mm-hmm. <affirmative> and see if that works. Okay. Or the doctor might say, well, listen, we need to have physical therapy before a joint replacement to make it stronger so he can recover better. And then physical therapy afterwards, we've got 20 physical therapy sessions we need.
Speaker 0 00:13:29 They submit that to the insurance company. Insurance company says, well, how about eight? And so you get eight physical therapy sessions. Um, you know, it, it's a big difference. I've, yeah, met with, talked with people that, uh, for example, a hip replacement and they limp, you know, and I've, I've had my own hip replacement, and I said, well, why do you limp? Well, they talk to 'em, and they didn't have any of those pre-care and post-care and it, and it impacted them. So the benefit category is, you know, physical therapy or a joint replacement. Right. They both have that. But with, you have, with original Medicare, we're talking about in a second, you actually, the doctor doesn't have to get pre-authorization. It's doctor says, this is what you need. Then that's what you're gonna get. So, you know, if you have, most Medicare advantage plans are either an H M O or a P P O.
Speaker 0 00:14:20 Mm-hmm. <affirmative> and an H M O, you usually have a, a doctor, the primary care doctor who's going to, you have to get permission to go see a specialist, has smaller coverage areas, et cetera. P P O, you don't, um, you, you can see a specialist as long as they're in network, if they are out of network. And other very common misconception with P P O that you'll hear, well, you can see any doctor that accepts Medicare, <laugh>, it goes fact, it depends on the definition of cam. You can ask any doctor. But if they're out of network, they can say no. And they usually do, if they wanted to work with that insurance company, it doesn't cost them anything to get a contract with them. There's a reason they may not wanna work with that company. A personal reason. Yeah. So in either way, you've got a limited network.
Speaker 0 00:15:07 You have a doctor that has to get pre-authorization. Then if you wanna go down a real rabbit hole, you can look up. There's just had some major congressional testimonies about the problems of all of this, because we've had, uh, in the last four years, two separate in inve, what do you call it? Inspector General reports on this problem, because the insurance companies use that to delay or deny coverage. So you get the pre-authorizations, um, you, your benefits also change every year, ev so if they're calendar year plans, and that means you have to res shop that plan every year, and you've got a window we call the open enrollment, which is October 15th through December 7th. And during that window, you get to see what the next year's plans are and shop for 'em. And anything can change. Sometimes only a few things. Sometimes some major things change.
Speaker 0 00:16:00 Uh, but that's your window of time to shop for a new plan. And if you don't shop, then you know, you've, you've got a, another period from January one through March 31 where you can correct a, a mistake or make one decision. The, the advantage or the, the benefit of an advantage plan is they have a very low monthly premium, sometimes no monthly premium. And for those that are working, you know, on the edge, and they're, they're having economic issues that they're dealing with, that's often the choice that they make. Now, they're gonna have to pay more when they have healthcare needs. And they can, they can have a maximum out of pocket, you know, set, you know, at $10,000 mm-hmm. <affirmative>, it could be in the thousands of dollars, but their premium is low. So, you know, if you have a Medicare Advantage plan, you have to shop every year.
Speaker 0 00:16:49 Uh, you can shop and change plans without any discussion of your healthcare, your health history. Doesn't matter what it is. You can always shop for a new plan every year and change plans. The, and you'll typically have a prescription drug plan that is bundled within that. So, uh, there, that's a whole nother subject. But the prescription drug plan comes with your advantage plan. And that's the only way you can get it. Now, if you just stayed with original Medicare, that's the red, white, and blue card. If, if your parent stayed with that, then they have a plan that, uh, they can see any doctor go to any hospital, anywhere in the country. As long as they accept Medicare, the doctors don't have to get pre-approval. They don't send anything up to Medicare. It's, it's, you know, the doctor, if it's medically necessary, it gets done and it gets covered at the, the race that Medicare has.
Speaker 0 00:17:44 Some of the deductibles and copays change every year, but the benefits never change in that. And then hopefully they've added some sort of a Medicare supplement. A supplement pays the deductibles in those copays. They can still see any doctor go anywhere in the country. I mean, literally, there's a, a doctor a halfway across the country that will help with whatever rare condition your, your parent has. You can go, they won't pay for your airfare or your hotel, but your healthcare's covered. And with a supplement, the benefits never change. So you don't have to shop. In fact, you don't shop every year. It's pretty much the same. The, the biggest difference is one is there's a monthly premium, and for some that monthly premium is a burden for others, it's not. And you have to have a separate prescription drug plan. It's called a standalone prescription drug plan. And that, like the advantage plan, you have to shop every year, but you can shop and, you know, your, your prescriptions and lower your prescription costs without any impact on your healthcare. It's not bundled. So you don't have to choose between one or the other. You have no network. You have complete freedom and your doctor, and you are the ones who control your healthcare.
Speaker 3 00:18:55 Okay.
Speaker 0 00:18:55 And that's, that's the big difference between, uh, those two. And, you know, if you're new to Medicare, you get to make that choice of which path you're on. If you've chosen a Medicare supplement path with original Medicare, you can always, let's say the premiums get too high, you can always go to a Medicare Advantage plan any year. But if you go to a Medicare Advantage plan and you want to go back to original Medicare, if you're outside of that initial enrollment period, your first six months on Medicare, an insurance company can look at your health history and say, well, you've got critical or chronic illness that's costly, and we don't wanna insure you, so you can't get a supplement.
Speaker 3 00:19:34 Okay.
Speaker 0 00:19:35 That's why we talk about potentially making a permanent mistake. If you go to a supplement, you can always go to an advantage plan. You go with an advantage plan, and only if you're healthy can you come and change to a supplement.
Speaker 3 00:19:47 So that is the, the, and that speaks back to your earlier comment of you have that clean slate. Yeah. Do you, you only have that clean slate. Is, is it really, essentially sounds like it goes one way. It, it goes out of the, the Medicare plan. It, it's, you get the clean slate at that age 65 or where you, or whenever, by the way, is that the same if you say, I have a, um, uh, I'm still working and I decide to work until, you know, 67, 68, and I utilize work and it covers all of that, when I do jump into that, coming outta that, do I still have that clean slate the first time that I do come into the plan, then? No,
Speaker 0 00:20:23 That's a, that's a good question. As long as the person didn't work and get Medicare, which is Right, right, right. What we tell people not to do, a lot of people do. They think they have to get Medicare, so they have their employer plan and Medicare, your clean starts when you get Medicare Part B. Your part part B is your outpatient services. Um, your Medicare part A and part B are called original Medicare. So, just, just to be clear, part A is your inpatient, whenever you're an inpatient in the hospital or hospital nursing, you know, whatever you, you've got, that's your, your part A most people, part A is already paid for. 'cause it's paid when you have your payroll taxes. If you or your spouse worked for at least 10 years paying your Medicare tax, then part a's completely covered. If, um, if you haven't worked, then you know, you, you and, and you have to have been in the country for at least five consecutive years, uh, then you can get Part A, but it's gonna cost you a monthly premium.
Speaker 0 00:21:27 Uh, part B has a monthly premium, and that monthly premium is dependent on your income, actually your income as of two years ago. And, uh, for, you know, most people, you'll have the standard rate for part B. And, um, you have to have, I think right now it's an income over 95,000 individually and 180,000 jointly to start paying more than that standard rate. Uh, but the Part B is the one that, uh, once you start that, then your, you know, your initial enrollment period starts for a Medicare supplement, you've got 180 days, you know, six months. Uh, you've got, um, and if you change your, your, um, employer plan, you've got 63 days if you're gonna get a Medicare Advantage plan or, uh, to get a prescription drug plan. You know, so there's all these, there's, there are so many different enrollment periods. I've got information on my website to go through all of them, but they're, they, that can be really confusing, don't assume just because of supplement six months.
Speaker 0 00:22:31 Everything else is, in most cases, think of it as your initial enrollment period, which is, it's called seven months around your birthday month. It's your three months before your birthday month, three months after your birthday month and your birthday month. Um, and then a Medicare supplement. If you, especially if you've delayed it, like you were talking about, uh, then you're 68, 70, whatever, you get your Medicare part B, now you've have that new, that's your initial enrollment period, so to speak. Or your special enrollment period where you have six months to get a supplement. Or if you wanna start, uh, an advantage plan or, and get a Part D plan, you got 63 days.
Speaker 3 00:23:06 Okay. That, uh, so that makes sense off of that clean slate, and I can understand where those things come through, the supplements you talk about. Let's see. Uh, and you hadn't used it before, but Medicare Advantage that's known. Is that Part C, is that right, typically?
Speaker 0 00:23:21 Or is that That is, yeah, that is part, that's, yeah, it's called Part C, used to be called Medicare replacement. Uh, that was its original name back in the eighties.
Speaker 3 00:23:29 And then just kind of, kind of hidden down the, the, the s sequentially down here, D is is prescription, is that right?
Speaker 0 00:23:38 Uh, d is a standalone prescription drug plan. Correct. Okay.
Speaker 3 00:23:42 Okay. And, and how often is that? Is that used to both with a C and used to augment what may be covered in an A and B if you're utilizing Medicare? Or
Speaker 0 00:23:53 Is it usually so No, it's, so if you have an advantage plan, then the Advantage plan is supposed to have the A and B services. Yep. There, there are advantage plans that don't come with, um, a Part D plan, but there's almost 90% of them do. And you, if you, you can't get a standalone Part D plan with a an H M O or a P P O Advantage plan. So if you have that, you get one that's bundled in there. It's still separate. And, and what's important to understand there, so if you're, if your Advantage plan says, well, you have a maximum out of pocket of $5,000, that doesn't include the Part D portion. That only includes your inpatient or outpatient services. And only if you, you know, uh, follow the rules of the Advantage plan. So if the Advantage plan says, well, we're not gonna approve this service. And you know, I've had people call me that, um, had and needed, you know, organ transplants literally, and, and, uh, advantage Plan would deny it to make them fight for it. Yeah. And, and if they went ahead and got it anyway, then it wouldn't be covered at all. So we have to go through an appeals process to, to get that covered.
Speaker 3 00:24:59 Well, I think that may, that's one place, and I imagine you, you hear where families will get tripped up in understanding they're, they're trying to forecast without help how much cash is gonna come out. And a lot of it, it gets missed in that, well, what is max out? Well, I thought this was a max out of pocket, but it didn't include maybe what we see coming out pocket here and this over
Speaker 0 00:25:19 <laugh>. And that's, it's one of the other reasons that I prefer a supplement if a person can have one. So with, uh, the most coverage you can get if you're new to Medicare today, is a, a Plan G and original Medicare. And with that, your maximum out of pocket for inpatient and outpatient services, $226. That's it. You pay that, that's your part B deductible. You pay that everything's covered a hundred percent. Your doctor, you know, doesn't have to ask permission to, you know, get you a surgery or a, you know, physical therapy or whatever else you need. Uh, in addition, if it, it also includes things we call Part B drugs. So, uh, you think of a prescription drug plan part D as your drugs, but that's only the drugs where your doctor writes a script and you'll either get it on a monthly basis or pick it up at a pharmacy.
Speaker 0 00:26:10 Your, your part A, uh, inpatient services covers all the drugs that you have when you are an inpatient. Okay. And your Part B includes any of the prescriptions that you would get that are administered by a medical professional at a medical facility includes a lot of infusions, uh, includes, you know, many of the, uh, shots that people will get, they don't wanna give themselves. Um, some things could be one or the other. And we get that a lot with, uh, osteo osteoporosis and osteopenia. The, I think it's called Prolia, if I remember correctly. You can, a lot of doctors will say, here, you can, you know, take this at home. It's only $30,000 <laugh>. Yeah. If you have, if you have a Medicare Advantage plan, then you're gonna pay 20% of it up to the maximum out of pocket. If you have original Medicare and a supplement, then it's paid for.
Speaker 3 00:27:09 Okay.
Speaker 0 00:27:09 You don't have to worry about it. So, you know, and that's when we talk about the choices. And once you know the, which, which one you have, if your parent has a Medicare supplement, uh, your only concern at that point and is, you know, it's, but no matter what their health is, is, is, you know, pretty much what's the premium gonna be. Yeah. And even if the premiums go up, it saves everybody involved. The expenses of medical care. Uh, it's just, you're not gonna have this, you know, surprise $20,000 bill if you have an advantage plan. And we do get this a lot. People say, well, advantage plan has, I'm just gonna use 5,000 as around number $5,000 maximum out of pocket. How come I spent $30,000 this year? Well, because you were denied services that you got anyway. It doesn't cover that. You know?
Speaker 0 00:27:59 Uh, so if you're denied a service, you have to go through an appeals process. Now, statistically, 80% of all appeals are successful on the first try, and another 10% are successful on the second try. Uh, 'cause it's a, it's a delaying tactic is all it is. Sure it is. Yeah. You know, and, and it's not a, a complicated process. It's just frustrating. 'cause it's, you're being kicked when you're down, so to speak. And a person who's going through something medically is not necessarily in the best position to wanna fight to, to, for approval. We had one case and a, a woman, and again, this was actually the, the, the daughter helping the mother and the mother needed, uh, surgery on her sinuses. She, I don't know what it was, but she could not breathe through her sinuses. Insurance company writing wrote back in so many words saying that breathing through your sinuses is not medically necessary.
Speaker 0 00:28:55 I always breathe through your mouth and I laugh about it. But that is literally what they come up with because that's all they have to do is say, this isn't medically necessary, we don't have to cover it. Yeah. And so we walked 'em through the appeals process. We're not attorneys. We can't do it for 'em, but we show 'em how, so that it's, this is really easy to do here. You do it on the first appeals, you got everything that, uh, so the, the parent was got the surgery and had that corrected and can breathe again.
Speaker 3 00:29:22 Well, and those are, I think you you point that out that this isn't, it's, uh, it's not nefarious to understand that insurance companies are insurance companies and if that's where you're going to mm-hmm. <affirmative>, they're there to make money to hedge risk. And so if they can, if they can delay or to see really how badly do you want, that one thing, especially in a medical marketplace that is, is quick to just start throwing stuff everywhere. Yeah. Um, they've, at some point in time, they've gotta build in some level of protections to make people go take a breath, you know? And, you know, from that side, take a breath, make sure this is really what you want. Now on that particular case, that's very interesting. And what the, just do it through your mouth, not through your nose, <laugh>, <laugh>. But, but, but, uh, you can, I, you know, I can kind of understand where that comes about.
Speaker 3 00:30:06 It doesn't make it easier in that moment, especially because typically those, you, you feel like those decisions have to be made very, very quickly. The doctor's offices mm-hmm. <affirmative> will push on you. The medical specialist will push on you, your heart's pushing on you to kind of work that thing out. Uh, and you have to work through that. Is there, is there generally a, a, a guideline for how long an a an appeals process or something? Is that a, is that a, a couple of week thing? Is that a couple of month thing? Just at high level?
Speaker 0 00:30:34 Yeah. You know, you are typically looking at, at 30 to 60 days that you have to respond with an appeal. Yeah. And you have to have certain paperwork and the insurance company's required to give you that paperwork. They don't always do that. So, uh, we, what we tell people, if there's something like that, that gets denied, the first thing you do, you know, I our clients do is, is call us. 'cause then we will get, you know, make sure you get the right paperwork, make sure you get everything you need, and get it through that process as quickly as possible. Yeah. To get it started. Uh, the, you know, it's the people that unfortunately is a Medicare statistic that over 90% of the people had no idea they even could appeal because they don't get a letter that says, you can appeal this. And so they don't know what to do, and they put it off and sit around and the, you know, that time period, you know, passes, in which case they're gonna have to start all over again.
Speaker 3 00:31:25 But they, they go back in to see that doctor four months later who is like, we just, you could appeal that and that will, you know, come through or Yeah. You just have to show 'em this document that says, we tried this medication at this level, it didn't work. This is the next level of medication I'm asking for.
Speaker 0 00:31:40 Yeah. The medications are different, and those are actually easier appeals, but what you just referred to was step therapy. And that's, uh, very common for expensive prescriptions. And some of these have gotten to be ridiculously expensive. Uh, and, you know, the, the Part D plans though, have gotten actually better over the years. The, uh, they, they're doing a lot. There's even coming up with, now in 2024, there will be a, we call a soft maximum out of pocket of about 3,300, depends on what type of drugs you have. And then in 2025, there will be a fixed maximum out of pocket on your prescription drug plans of $2,000. You know, all the years behind us had no maximum out of pocket. Yeah. And it could be devastating if you have, you know, cancer and stuff, and Medicare's, you know, paying 95% of your drugs after you've had a certain amount out of pocket, but the average cancer drugs over $10,000 a month, then, you know, having a $500 a month for, you know, if you get, uh, certain cancers, you have to take that the rest of your life. That's, that's a big expense. Right.
Speaker 3 00:32:43 Well, and you, you look to understand, again, an importance in probably looking at this, which will strike in a bit, uh, annually shopping that and looking at that, it's tend to find these things are like a, uh, like a water better. So you can push down into one area and it's gonna pop up mm-hmm. <affirmative> someplace else. Right. If there's a limit in one place, you're just gonna have to kind of continue to look back and understand how that change comes to. So I, I look forward to hearing how you think we do that.
Speaker 0 00:33:09 Well, the, the worst case, you know, no matter what you do, if you res shopp, that's easy to do. Uh, whether you're, whether you're doing a, let's say a prescription drug plan, you know, I've got a, a process I use, I have a website called part d shopper.com, and you can put in your prescriptions and which pharmacy you like to use, and it'll list out the, uh, drug companies that I recommend with the lowest one on top. And you just, you pick that. 'cause all the drug companies have to cover at least two drugs from every category. And, you know, they've, they're, then they have to cover substantially all the drugs from the six protected categories, which includes cancer and immunosuppressants and such. So it's not like you're gonna have a plan that doesn't cover what you need, but what you don't know is what is it gonna cost? And yeah, it, that depends on what contracts that particular insurance company has with the different manufacturers. And that's why shopping every year you say, okay, these are my prescriptions. Who's gonna gimme the lowest cost on those? And that's really easy to do with the standalone, with, um, a Medicare advantage plan, you sometimes have to balance the ones that have your doctors in network versus the ones that are not gonna overcharge you on your drugs and, uh, or change doctors.
Speaker 3 00:34:25 Yeah. Well, you know, and these, these are, these are not unlike, uh, what we can be doing and, and should be doing with our own coverage, medical insurance coverage. I think even, even if your work provides you one when you're younger from that, I think one, one thing you and I have talked about before is you really have to change an outlook after retirement and, and how you look, how you set yourself up for your expenses, how you plan for those things fiscally and financially. Mm-hmm. <affirmative>, I think we, we, you see perhaps when you're younger and when it's covered by your employer, it's the oops, as that come through, it eats more of your, eats more into that expendable income, but there's a significant amount of income that's starting to come in from that, and it kind of covers over. You can get into a bad habit of not looking at those things and just kind of sucking that up.
Speaker 3 00:35:13 And then, especially if you're in an employer that's changing plans routinely, once you, you've figured it out, <laugh> the next year, it's gonna change to something else that gets thrown at you. Um, but when you, when you get into this, again, I, I know we're gonna touch this here in just a bit about shopping that plan even deeper. Um, this is, it, it, it can really matter, particularly helping a loved one to make sure that you're staying up on those, those changes that are gonna come at them for the next year. Uh, yes. You, you talked about that window, that October 15th to December 7th. During that point in time, I would take it that at the beginning of that is when we will begin receiving, we receive, if I, for whatever, let's say I'm, I'm either, either, whether you're peer, you know, that pure play part A and B working with Medicare, or I'm on a Medicare Advantage plan and a part C kind of Medicare Advantage plan. Mm-hmm. <affirmative>, will I get, will I get that in October or right at the beginning of that time period and window to Yes. Begin looking at that or about when does that information come in?
Speaker 0 00:36:10 Right. So the insurance companies are required to give you a statement of change from about October one. It's usually within the first couple days of October. Right. And that gives you a couple weeks to look at it. Uh, and, and you know, then, and you, you may even on on medicare.gov or some other sites, you know, see some of the plans and their changes and, you know, we can see everything on October one, but we can't do anything about it until October 15th. And which is good though, it gives us time to look, to study, to research. And, uh, you know, by the time things start, uh, where you can make a change, uh, then, uh, you know, we've had time to look at it, whether it be your prescription drug or your Medicare advantage or whatever. Uh, and uh, the only only issue I have with that is it's always during the holidays, you know, during Thanksgiving and holding up to Christmas and stuff. And, um, that's, that's hard for some people, especially around Thanksgiving. They, they don't exactly want to be thinking about their Medicare at that point.
Speaker 3 00:37:09 Right. Well, it, it does, in, in a case of a parent project, it might, might give you that opportunity when you're in person to ask what questions they are. Mm-hmm. <affirmative> be able to assess what your parents' capability is of understanding where they're at and what that plan looks like, and how to walk their way through it. Maybe even ask some of those questions if there was something that they were aware of that didn't get covered, or if there was that bill that popped out that they weren't expecting to identify if there was an appeals opportunity or, or something there to walk 'em through. Um, those, those become some of those moments to have those conversations. That's awesome insight from you. So we, you, you talked, uh, some of these supplemental, these, these f the g the supplemental type stuff that sits out there mm-hmm. <affirmative>, um, Medi Medigap. Right. Tell me about that term. We hear this Medigap. Is that, is that just another way for supplemental, a supplemental policy?
Speaker 0 00:37:57 Yeah, it's the exact same thing. A Medigap and a Medicare supplement for the same thing. And, uh, you'll find, uh, you know, that's in the industry, we usually refer to 'em as Medicare supplement, but when you get online at Medicare, they usually refer to 'em as Medigap. And they're, they're paying the gaps in Medicare, the deductibles, the co-insurance, you know, Medicare Part B we mentioned is your outpatient services. Um, that is typically after a a $226 deductible, your Medicare's gonna pay 80%, you pay 20%, or the Medicare supplement will pay that 20% for you. Or, you know, Medicare Part A has a per event deductible of about $1,600. Um, you know, your supplement will pay that for you. So you don't have to do that. Matter fact with the, almost all the supplements, you can be in a hospital for a year and it won't cost you a dime as an inpatient.
Speaker 0 00:38:49 So, um, but yeah, Medicare supplements there, the, there are 10 Medicare supplements available, but the vast majority of plans are of one of three. And by vast majority, over 90% are one of three plans. It's either the Plan G and they're creative names. They just stick a letter in there. That's the plan. Yeah. Um, but a, but Plan G covers everything for inpatient and outpatient. So they only cover what Medicare covers. So, you know, the supplement doesn't, it's not, you know, Medicare doesn't cover dental services, so your supplement's not gonna cover dental services. Just that if Medicare covers something, then the supplement has to pay the, you know, deductible or copay or whatever is associated with that. You never have to worry about does your doctor. So if a supplement will come from an, an insurance company, but you never have to worry about if your doctor accepts that insurance company. 'cause your doctor doesn't bill them. They bill Medicare, Medicare pays its portion, sends an electronic message to the supplement. Nowadays about 85% of those bills are paid within 48 hours electronically without any human intervention. The others are typically paid within a week or, and covers everything, uh, for that $226 part B deductible.
Speaker 3 00:40:11 Um, and then there's a, there's a, I understand with like an H or G and H is easy or just about everybody can qualify for it or something to that nature versus a g that might be more difficult Or what, what's the difference when you're looking between those types of, well,
Speaker 0 00:40:24 You know, yeah. There are no supplements that everybody can qualify for at any time. Okay. Okay. Um, there are, there are different ones that have, they'll have a different price to 'em and have different benefits. Um, so example, the second most popular is the Plan N. So like the Plan G covers a hundred percent of your inpatients. You never have to worry about an inpatient bill. You also have to pay that $226 deductible, just like with Plan J. But with a Plan N you will also have a $20 copay. When you ever have an office visit, that's gonna include, you know, nowadays it includes, uh, telehealth visits. It can include an urgent care visit. It's most doctor visits. It doesn't, it's a, it's a visit where a doctor is either di diagnosing or evaluating you. So physical therapy should not have a copay to it, but it's a 20, it can be no more than 20.
Speaker 3 00:41:16 And are you saying M as in Mary, or N as in nor?
Speaker 0 00:41:18 Oh, I'm sorry. N as in no. Or November N
Speaker 3 00:41:21 As in no. Yep.
Speaker 0 00:41:21 Great. Okay. Um, it's the second most popular plant. It is gaining in popularity because it is, uh, a lot lower in price than a Plan G and a lot more stable in price than a Plan J is. And, uh, it's, uh, so it's a very popular plan. It is. We always look and you compare it, let people take a look at the plans available to 'em, let them compare, make the decision which one fits their budget and their needs. Uh, there are, the other, the third one that's most popular is a, is a high deductible. So your Plan G has a high deductible version, so does a plan F there. Um, and it's the same plan, even though they have different, you know, g and f high deductible or exact same plan, and in essence there, so your Medicare is still gonna pay its portion.
Speaker 0 00:42:10 You go to the doctor, you pay the part B deductible, uh, you after the deductible, Medicare pays 80%, you pay 20%, it just puts a maximum out of pocket of $2,700. Uh, and that's after that you have a hundred percent coverage, but you're usually looking at a premium that's, you know, well under a hundred dollars can, depending on the state, you know, prices on supplements vary wildly by state and even within a state. And so, uh, it could be $40 for a high deductible plan, could be 90 for a high deductible plan, depending on where you're, and, but the bottom line is, it's a way of having something better than an advantage plan because you've got a low maximum out of pocket. You the freedom to see any doctor you want. Your doctor isn't handcuffed or handicapped by anything, uh, without having a larger out of pocket, uh, for a premium. So
Speaker 3 00:43:05 Those are, uh, certain, one, one of the top things where families tend to start pushing out are those diagnoses of like, uh, dementia or where there's gonna be a reduced capacity long term. Is that a, is that in particular, since we're seeing, we've see an explosion of that it seems to be, uh, in, in the United States today. Does that, does that come into, do things like that at that level? Does that something that might come into play when you're working through a decision like this?
Speaker 0 00:43:33 Well, so that is why one of my philosophies I preach in my seminars is you get today the insurance that you'll want to have when you're sick or injured. Because once you have a condition like that with Parkinson's or Alzheimer's, one that's showing an ongoing chronic condition, an ongoing cost. If you don't already have a Medicare supplement, you can't get one. However, the Medicare Advantage plans are changing and improving, uh, to such a degree. They're now special needs plans for certain chronic conditions like diabetes and heart conditions. And they'll be, you know, more introduced with, you know, for, uh, Parkinson's and, and Alzheimer's, et cetera, that Medicare Advantage plans that are designed for that. So you have a, a better drug plan for that specific condition and a better structure of the plan to keep your costs down and make sure they get the care that they need. So it's one of the good things about Advantage plans is if you, you, if you miss the supplement, these advantage plans are changing and every year are getting into, uh, better and better to help people with those special needs, with
Speaker 3 00:44:41 Those special That's fantastic. That's great to know, to be on the lookout for. Um, so, and I think, we'll, we'll circle back around the best way to get visibility on all that. I think also in, in, along with our, our shopping annually, uh, I think that leaves the, the, the, the last letter I'm trying to tick off on my little checklist is an is an H What, what is a plan? H <laugh>?
Speaker 0 00:45:03 I don't know that there is one. Okay,
Speaker 3 00:45:05 Great.
Speaker 0 00:45:06 There, there were different, there were different lettered plans, but many of them were, you know, were discontinued. Uh, back in 2010 when Medicare supplements were call 'em modernized. They were, they were changed and improved. Got it. Um, so,
Speaker 3 00:45:20 So these, these letters that we use, is that an antiquated form or are they still, are they still being used kind of regularly? I noticed when you let off, you didn't use, you didn't use those originally. Is that something we would expect to get worked out of the system, or is that still a part of the Yeah,
Speaker 0 00:45:35 That's vernacular.
Speaker 3 00:45:35 That's,
Speaker 0 00:45:36 So one good way to confuse people is throw terms they don't know. And, and Medicare does a good job of this by saying A, why don't they just say inpatient care B, why not outpatient? And the problem is that there's also a Medicare supplement, part A, a Medicare supplement, part B, a Medicare supplement Part D, that have nothing to do with, you know, Medicare, you know Medicare, right, Medicare, yeah. And it can be very confusing. So we don't normally throw all of those out until we talk about the concepts of the plan. And then, you know, we've got tables there, we've got online, we have all sorts of resources where you can see, uh, each of the ones that are available, uh, and what their benefits are. Uh, it's, but the vast majority of people that are, um, on a supplement plan, you know, we'll stick with some of those. You know, there's, there's the, uh, the f which covers a hundred percent of everything, but you could only get it if you're qualified for Medicare prior to 2020 G covers everything. But that part B premium and has other little things that you have to watch out for. But it's very easy to manage very low cost and more than anything else, it's very stable price wise. Yeah.
Speaker 3 00:46:51 So, uh, okay. We're, we're, we're gonna take, we're gonna take one more break here. Uh, this, this front side, you know, in that quick recap from it, we've seen, uh, where to start. What are the first documents you are pulling together in, in, uh, in understanding what that Medicare picture might look like? And I think one of the key things we've really talked about here is being able to understand and select the plan that you're going to need when you need it. And so doing that by discussing what those needs are, uh, what, um, don't get tied up into the letters and offer the terminology from that. Just work through what you think the situation is at that point in time. When we come back, uh, with Matthew Clawson, we're gonna be talking and digging down into how do you shop these plans now, you know what you think you're gonna need into the next year?
Speaker 3 00:47:39 How do you shop this annually? How do you do this in a way that that is safe for a loved one? That how can we reduce some of that risk, especially if it has to do with being online and some of those things. Um, and then what are some of those key circumstances that might change within a year that, that could influence us? Stay tuned. We'll be right back after this and making Medicare digestible with Matthew Clawson on the Parent Projects podcast. Stay tuned and welcome back. Today we're talking about making Medicare digestible with Matthew Clawson. Matthew, thanks again for joining us and helping us break down and even drink out of a fire hydrant. You're doing a phenomenal job, by the way, <laugh>.
Speaker 0 00:48:16 Yeah, it's, um, hopefully no one feels like they're drinking out of a fire hydrant. That's <laugh>.
Speaker 3 00:48:22 I think when you just look at the whole, the whole thing, this is one of those easy things that you look at and you're like, uh, tomorrow <laugh>.
Speaker 0 00:48:30 Yeah, exactly.
Speaker 3 00:48:31 You know, and unfortunately, many of us probably got many, many years of experience with that, with taxes, maybe tomorrow. Yeah. Yeah. But, but, but this is one of those things that really gets at you, and it's constantly, it's dynamic. It changes every year. You brought up a couple of times now, and we've had conversations about the importance of looking at this every single year, uh, and being able to, to shop this, shopping a plan, shopping a plan annually. What does that look like? What do we need to know about that?
Speaker 0 00:48:58 Well, there are a couple avenues people can take, and Medicare has done a, a better job each year of allowing people or giving people the opportunity to, to get online and shop for certain plans. Mm-hmm. <affirmative>, uh, prescription drug plans are pretty easy. And again, I have the part d shopper.com website through the companies that, not all the companies that are available, just the ones that I prefer to work with. And, um, you know, you, you, if you're going to shop, so the online is one way. Now, what we encourage people to do, obviously, is to, to call us. 'cause we have a, a software system that's probably some of the most sophisticated software in the industry where we'll collect a person's, you know, who are their doctors, you know, which one is their primary, who are the specialists that they say will collect, uh, the prescriptions that they're currently taking.
Speaker 0 00:49:45 And then you sit down with them and what'll the, the software spits out is all of the insurance plans that are available to them that are, you know, if the advantage plans where the doctors are in network and you can see what they cost, you can also say, well, is it, you know, gonna be, which one has lower cost for, uh, uh, the prescriptions? And then which ones, some of them have deductibles, some of 'em have different copays and all of that. And we can go through all of those changes. So instead of somebody calling all the different insurance companies, we have it to get there together. The prescription drug plan is the same thing, uh, except it's done online. And, and most people don't even need our, uh, you know, need our help with that. We're there to help them. But it's, it's a very simple process.
Speaker 0 00:50:29 But if you can't do it online, and we'll get this on occasion, we'll have people that'll have a lot of medications mean sadly, you know, 15, 20 medications. And so there's something called the Medicare blue button now where, whether it's through our software or whatever we have, you know, we can through this blue button import all of their medications, all of their doctors, everything into our system. So we don't have, no one has to manually type it. Uh, the, the, the person who's trying to help doesn't have to take all these prescriptions out and see which ones they have, et cetera. It's all automated at this point. Uh, only thing we do is make sure there's not something in there that they aren't taking anymore, or that the prescription's changed. And when you go through all of those plans now, you know, one of people may not be aware, our services are free to the consumer.
Speaker 0 00:51:21 We don't cross anything that we can work with any of the major insurance companies and all the supplement plans and just whatever is right for the person, the insurance company's gonna pay us and they pay us the same regardless. So all we're trying to do is, is get somebody into the process and take something that would, could take days and many, many hours on their own and take it down to a very simple process and, you know, be, be done in 30 minutes in many cases. Uh, just remember with a supplement, you don't have to shop every year 'cause the benefits never change. Mm-hmm. <affirmative>. So you can just keep that for as long as you can afford the premium. No one can change it, no one can take it away from you. Prescription drugs and Medicare Advantage plans have to be res shopped every year.
Speaker 0 00:52:04 And, um, just a, a quick story. There's, uh, gentleman, I, I, about four years ago I remember, was helping him with his prescription drug plans. Already got a supplement for him and, and, uh, he was 70 something. So he'd been on Medicare for a while, was, um, he didn't have a lot of drugs, but he kept telling me he was, he was spending $12,000 a year on his prescriptions. And, you know, the reason was is he, he never re-shaped his plan and the benefits and prices change every year. So if you keep on the same plan, you can end up, in this case he's paying 12,000. I went shopped for him, brought him down to about $1,800 a year for that. And he started crying and I was like, you know, um, you know, don't, don't cry. It's okay. And he goes, you don't understand. I, I could afford to see my grandchildren now. Huge difference, huge difference in the quality of life. And, uh, that's why we make sure now, uh, that, you know, everybody is reminded to res shop your plan. 'cause once January comes and you've not shopped your prescription drug plan, there isn't anything you can do about it.
Speaker 3 00:53:16 So, uh, talk to me, just I didn't, or adding into that, you did talk about a January to March 31st for corrections to be made. Can you clarify what that, what that section is for that timeline to
Speaker 0 00:53:29 You for Yeah, that's, that is referred to as a Medicare Advantage Open enrollment. So you can make one change in Advantage plans. It's, it's not uncommon for the websites of the insurance companies to not be up to speed. So you think your doctor's in network, you find out in January that they're not, or they canceled their contract, et cetera. So you can make one change any change you want with your advantage plan, or you can go from an advantage plan back to original Medicare and get a prescription drug plan. You cannot change prescription drug plans during that part. There's, there's a big movement, uh, within our industry to add that because it's needed. Uh, insurance companies have quickly learned that since you can't change plans, that their price increases all occur in January <laugh> after you've made the choice. So, you know, that'll happen in the years ahead. They're improving that, uh, literally on a yearly basis. But for right now, that enrollment period is if you've, you know, made a, if you don't like your advantage plan, you can get a different one or go back to original Medicare. You can apply for a supplement and if you're don't have any, uh, major health history, you can get one mm-hmm. <affirmative> and you can apply for a prescription drug plan.
Speaker 3 00:54:45 Okay. That is incredibly well laid out. What, um, outside of, of, you know, those, those questions that come from that, are there any other major things that could happen in a course of a year? Uh, or, or anything else that, that comes up or That's that's the window. That's where it is. That's actually pretty hard and fast. There's not if, and I'm thinking big stuff like loss of a spouse, right? Or, or, um, may Well, I don't know. I don't know. Don't,
Speaker 0 00:55:14 Good question. So there's, um, yeah, there are what we call guarantee issue periods. Okay. Uh, Medicare advantage plans are local coverage. So let's say that your parent moves, you know, they're in d different state and they move in with you. Well then I think they have a guarantee issue. It's a 63 day period from the day that they moved, or the day that they tell Social security, they moved and they can get certain supplements, maybe an F or a G depending on their situation when they started Medicare. And, uh, a a d you know, a med, not a Medicare part D, but they can do that too, but a a a Medicare supplement plan D. And, um, but they have a guarantee issue where they can get certain Medicare supplement plans without any health questions asked. Hmm. Or they can change Medicare Advantage plans and get a local Medicare advantage plan or get a local prescription drug plan.
Speaker 0 00:56:07 So that's very important. You have a very short window of time to do that when you move. But the, the key is that it's when you tell Social security, you moved and they, they've changed that rule here recently to make it easier to work with. There are other, uh, guarantee issue plans. If your Medicare Advantage plan closes, that happens on occasion, you have a guarantee issue to get another one. Um, if you started Medicare on a Medicare Advantage plan, you've got a, a whole one year trial Right. Period. Where you can go to a supplement. And so your whole first year on Medicare, uh, you can change your mind and get a supplement if you wanna. And there's, there's on and on and on. There's, there's a lot of guarantee issues. There are some states like California that have, you know, a host of guarantee issues.
Speaker 0 00:56:57 There are other states that have or guarantee issue, uh, periods. There are other states that have and, uh, growing every year will have, uh, periods of time around your birthday or around the anniversary of a Medicare supplement policy where you can change supplements without any health questions. And there are some states where it's perpetual, New York, Connecticut, for example, you can get a supplement anytime without an ever answering any health questions. So all of that, you know, those state rules hard to play on actually familiar with them all because they keep changing. Right. But they're, they're, you know, those are the things you wanna speak to an expert about what state rules, you know, my, um, you know, I I, there was a period once where a, um, you know, a, a person, again, it just happened to be a, I, I think pretty much shows that the daughter and the, the, uh, parent was living in Texas and he had cancer and he was on an advantage plan.
Speaker 0 00:57:55 Cancer can be very expensive on an advantage plan. They're only gonna cover 80% and you're gonna the 20% up to the out pocket. The parent moved to California in doing so, they got a guarantee issue, period. We got 'em a plan F. So everything is covered a hundred percent. And as I was speaking to him with California, if that plan F gets to be too expensive during his birthday, uh, period, in any year, he can move down, move down to a plan N if you want it, or a G or whatever else to lower the premium cost. Mm-hmm. <affirmative>, so, you know, it was a, a win-win situation. They, they don't have the expenses of cancer. They get their supplement and they have, they're, they're in a state where they can lower that supplement cost, uh, every year. But, you know, if, if as long as it's available.
Speaker 3 00:58:46 And, and those are again, so you, you're making that big point that it is state by state. Yes. So if a parent project, if you've got a parent project that is, that you identify is going to have a state to state push, or there's gonna be an element, mom and dad are gonna move from one state maybe to be closer or whatever that reason might be mm-hmm. <affirmative>, um, then it is important to get in front of that again in thinking about the plan you're going to need instead of necessarily what you necessarily need at the moment.
Speaker 0 00:59:13 Exactly. Exactly. And we, we work with that. And the one thing I'll add to that is the way the rules work, it's the intent of moving. You don't have to move and get your residency at that state. Some states, you know, in South Dakota, you can drive an RV in and stay overnight and, you know, be a state resident. Uh, other states you've gotta stay there for six months. Well, that's nothing to do with Medicare. With Medicare, they've stayed, you know, as, as long as you have the intent to move, an intent to move shows that you've got an address that you're gonna move to, um, you know, whether it be, uh, your own house or a relative's house, then you can start planning your Medicare and changing your Medicare towards that.
Speaker 3 00:59:54 Interesting. Okay. Really, really fascinating on that. Um, any, uh, any other major significant, uh, things that you can think of off of the, the top of your head from that? That is,
Speaker 0 01:00:08 Well, um, we often get questions on, um, you know, does, what does Medicare cover? And I've got, uh, 50, 60 articles on my website on all the different things that Medicare covers. And the most important thing to think, if it is original Medicare, the intent is to cover everything that's medically necessary. Now, there are some things it doesn't cover very well, like wheelchairs are not gonna pay, uh, you know, a hundred percent of your wheelchair or your walker and all those, the, the medical devices, um, et cetera. But again, with the supplement, it's, it's gonna be pretty much covered. Yeah. But, but it's, it's important because, you know, some people will stop and say, well, what if I get this to happen to me or that to happen, or, or my parent goes through and gets this condition or that condition. If it's original Medicare, it's supposed to cover whatever is medically necessary, uh, hospice care is covered at a hundred percent. There's, there's home healthcare. If they are confined to their home, physically not, it's not a choice. I mean, it's, if they, they can't leave their home, then Medicare's gonna cover for home healthcare. They don't just cover if, um, the old person's only problem is they can't, uh, keep up with their activities of daily living. Right. They're has to be a condition or a disease or, you know, something to that nature that's keeping them in the home.
Speaker 3 01:01:31 Well, those tell us now, uh, since you, you have brought up, and we'd love to, we'd love to highlight you. Where can people find your, where can they find your website? Where can they find more with you guys?
Speaker 0 01:01:41 Well, the website is medigap seminars.org. Great. Um, uh, there's a host of videos. Uh, we've also have a YouTube channel, meap seminars.org, YouTube channel. Uh, the videos are both on our website and on YouTube. Uh, the, on the, um, on the website, you've got a search button and you can, uh, search for almost anything that would covers, it'll pull up the article on it. We've got calculators on there, you know, to determine initial enrollment periods or supplement enrollment periods or comparing an employer plan to Medicare. Um, all those calculators that are on there. And what'll happen very shortly here, this is, uh, within the next two weeks is there's gonna be a popup where, uh, you have a free Medicare mini course. And so I've taken some of my videos and just, you know, kept them down to short 10 minute videos to walk a person through learning about Medicare in, in four, you know, 10 to 12 minute videos. So, uh, all of that is there. It's, it's an meant, it's a site, you know, medigap seminars.org is there to help people learn without any stress, without any pressure on their own time. And, you know, it's become quite popular 'cause of that.
Speaker 3 01:02:54 Uh, and, and we love it. Uh, why don't you throw out too, if you would for me, please, the phone number you had mentioned that you had for people would give you a call from time to time. What's a good phone number for you guys?
Speaker 0 01:03:04 Let's see, 808 4 7 9 6 8 0. Almost had a brain freeze there. Threw me off <laugh>.
Speaker 3 01:03:13 No, no worries. No worries. So, awesome. Glad to have it in there. Uh, Matthew, it is just, it's really been great to have you here. Uh, appreciate your, thank
Speaker 0 01:03:22 You. I really appreciate it.
Speaker 3 01:03:23 Yeah, it's, and, and breaking this down for us, helping us really digest Medicare, uh, I think you did an excellent job by the way of locking that down and just getting us started against what that is. Again, you know, if you're, uh, if you're joining us from whatever state you are, it does vary from state to state. So make sure that you check in Yes. With professionals for your state to understand that. Uh, happy to, to, um, have you get medigap seminars.org where that phone number we showed down below. And, uh, and we'll also put some information down below in the show notes to be able to find you, Matthew, in your, in your group down there. Great. Thank you. And well, thank you again for joining us and for sharing your time, talents, and treasures.
Speaker 0 01:04:02 You're welcome.
Speaker 2 01:04:08 Well, that's it for team this week, and thanks for joining us. If you've enjoyed the content, remember to subscribe and to share this episode on the app that you're using right now. Your reviews and your comments, they really help us expand our reach as well as our perspective. So if you have time, also drop us a note. Let us know how we're doing for tips and tools to clarify your parent project, simplify communication with your stakeholders, and verify the professionals that you choose. You can find us on YouTube, follow us on Instagram and Facebook. Thanks again for trusting us. Until our next episode, behold and be held.
Speaker 4 01:04:40 Thank you for listening to this Parent Projects podcast production. To access our show notes, resources or forums, join us on your favorite social media platform or go to parent projects.com. This show is for informational and educational purposes only. Before making any decisions, consult a professional credential in your local area. This show is copyrighted by Family Media and Technology Group, incorporated and parent projects l l c. Written permissions must be granted before syndication or rebroadcast.
