>> Good evening.

I'm so glad you're with us tonight on PBS for waiting for life ahead.

Last week our topic was Medicare.

It's that time of the year to make changes if you want to and a lot of you have questions about plans and about what might be best for you and when you need to even be concerned whether to make an enrollment plan or an insurance plan change.

Well, Greg McDonald is with us again.

I promised you he'd be back again this week and told you if you had some questions be ready to give us a call.

We're going to have this number up on the screen periodically in the next half hour.

We don't take any commercial break so we are yours for the next half hour.

>> OK, let's greet Greg McDonald.

Hi, Greg.

Hi, Sandy .

>> Were you did such a good job last week giving so much information and I'll tell you we had a lot of phone calls last week.

>> So if you have a question, get on the phone now and I'm guessing most of you have already received your Medicare book for twenty twenty two.

I think I said last week just seeing twenty twenty two is a little hard.

>> I'm finally learning to write twenty twenty one on my Entourage's but we have to make decisions.

>> This is a time this is the time.

Well Greg had told us that the enrollment time of the time for changes that you're eligible to make those was from October 15th which is passed already until December 7th.

>> Correct.

OK so you've got to make some informed and good decisions and we're going to try to help you do that.

Greg, let's start by talking about this enrollment period or a time for changes.

>> Is this what happens between now and December 7th?

What should most people be doing?

>> Well, this is the time to evaluate your plans, OK?

The main thing is that you certainly want to make sure that let's say let me back up a second in September.

Everybody that has a drug plan and an advantage plan received what they call an annual notice of change review that I know I know it's insurances but take a look at it because it actually does point out pretty clearly what changes might have occurred on your plan.

So look at that .

>> The other thing you want to certainly double check on it is your prescriptions are are they all covered ?

>> Are there any changes in the cost of those prescriptions?

You want to make sure that you you have that right going to next year?

>> OK, and we did get some phone calls about that because the drug plans are one of the key things that a lot of people want to look at is that the major reason people make changes in their insurance plan?

>> It can be it can be it also can be changes in medical things that are coming up, you know, for them personally or yes, sometimes sometimes my people might be looking at additional medical procedures coming up for the next year and so that might prompt a change as well.

>> It might have change of doctors, hospitals, whoever they're going to deal with.

>> Those are all reasons to review your plan to make sure that what you have is still appropriate for the coming year.

>> Well, I mean when you said, you know, check your doctors, hospitals or whatever for care you're anticipating it could be common.

>> I'm guessing that doctors can change plans also I mean change what they accept.

I mean maybe a dentist or I don't know some physician decides to change to out of network and then right.

>> You do.

Right.

So the good news is in our area most of the doctors are tied in with either Parkview or Lutheran so most of them are going to be in network and in ICU which is growing in the area most of them are in that we also have independent doctors who are not tied in with either one of them.

>> And so you have to check that are they commonly like specialists or specialists primarily.

>> But we also have some that are more holistic doctors.

Oh OK. >> All right.

That don't accept plans.

Yeah.

So you have to be aware of that and just because a doctor let's say is an either Parkview or Lutheran even though they should be in network sometimes they're not and so you want to double check things just to make sure how important, Greg, are some of the side things if you will, dental vision what's another one hearing?

>> Oh yeah yeah yeah.

How important are those things to people and are they worth considering a plan change?

>> It depends.

The big thing that people do most of all would be the dental but let me say up front the dental plans are there primarily for preventative and some comprehensive and comprehensive fillings extractions, periodontal work, those types of things and that's what's there if you're looking for major stuff and that's as we get older that's what we typically use caps, bridges, implants, that type of stuff.

>> These plans are not going to address that and that's where a regular dental plan will come in handy.

So don't switch based on that.

OK, switch based upon switch based upon what your medical needs are and what your prescriptions need are the ancillary stuff is nice but it's window dressing.

>> Look at what you're being covered medically and check your prescription because those do change year to year.

>> Speaking of prescriptions, let's talk about the gap, OK?

>> What is it and and how will it affect people and what should you do if you discover your and the gap?

>> Well, the way they set up the Medicare plans they have some plans have deductibles, some don't.

Some have a mix inside of them.

But let's say you're paying a copay and for an example let's say a drug cost one hundred dollars but the copay that you're paying is forty five.

>> Well, you may be paying forty five but the drug companies are adding up that one hundred dollars every time that you buy it and once the total of your drugs exceeds next year four hundred and forty dollars you go into this coverage gap.

Well what that means is the cost sharing changes from copay to a percentage now most of the time it goes up.

That percentage by the way is twenty five percent.

>> Twenty five percent of the retail cost of the retail cost right now cost what you would be paying.

>> It's the retail cost.

So something for expensive drugs often that means that your co-pays are going to go up.

Something might actually go down.

It just depends on the cost of those drugs and you're in that particular gap up until you're what they call the true out-of-pocket exceeds next year seven thousand fifty dollars and that's the combination of the total cost of drugs and what you paid prior to entering the gap.

OK, all right.

Any recommendations for people?

Well, I'm sure people ask you all the time what to do about Bill Gates.

>> Sometimes people are saying well I hope I hit the gap.

What am I going to do?

>> Is there anything I can do differently?

Yeah.

For next year it's yes or no.

Part of it depends on the on the drug companies formularies and how they cure the drug.

But if if it's something let me just grab a drug like crewless OK that's a big company.

>> I see commercials.

Yeah for that yeah.

If you could find a commercial on television PrimeTime time expected to be expensive.

>> Yes that's just the way it goes but anyway the most of the companies if you have a drug like that once you hit the gap it's going to be the same almost across the board regardless of where you're getting it from now there are exceptions I don't want to say you don't check it but when if you're talking to an advisory says I can't do any better, he might not be able to.

>> Yeah, because twenty five percent of five hundred dollars is twenty five percent of five hundred no matter how you cut it so but it's again check it it is worthwhile checking and I yeah routinely I talk with people and we have significant savings changing a drug plan over the course of the year so it's worth looking into.

>> Yeah I did that myself a year ago at your recommendation actually and saved about six hundred dollars.

Yeah for for almost exactly the same coverage.

Just very very little difference you know I'm happy about that.

Yeah.

>> Yeah but again it's an individual situation now you know what I might need medically or prescription might be totally different than somebody else.

>> Exactly.

Exactly.

And that's why it's individual individual you have to look at it your own OK in this book Medicare and you twenty twenty two are there major changes we should look at?

I mean I'm guessing most people are not going to read every word on every page unless they're really bored.

>> No major changes with Medicare itself.

OK OK there's no major changes.

>> The the big change that comes every year is OK what's the part B deductible going to be because that influences more people than than anything else .

They haven't announced that one yet but with the announcement that the Social Security is going to go up like five point nine percent, you can figure that the it's going to be a reasonable hike in that part B premiums.

>> OK, is that is that for sure five point nine percent increase but and Greg talked about this last week you know you think oh wow, I'm going to get a little more money but then they increase the cost of government giveth and the government taketh away.

>> So you're really going to probably kind of balance out no matter what happens.

OK, we had a lot of phone calls last week that had different situations that they they individual talked about.

>> But you mentioned a little while and a few minutes ago about watching commercials on TV right now you can't watch an evening of TV without seeing a couple of Medha care commercials.

And what's really interesting is that several of them are from celebrities I think the ones right now.

But I can think of our let's say Joe Namath, Joe Montana and what's his name Dynomite.

Jimmy Walker.

Jimmy Walker.

OK, and they run a lot.

Well, keep in mind as Greg just mentioned, those really cost a lot because they aired nationally and many times and there are some big production costs as well.

>> So who does that affect and should we because that's a celebrity because that's Joe Montana telling us something should we believe all of that?

>> Well, here's the thing with that what they're referring to our advantage plans if you're on original Medicare and they say are you missing out on benefits?

Well, yeah, what they're talking about are the ancillary benefits that go along with an advantage plan such as that dental vision hearing.

Yeah, most of these plans have some provisions in their gym memberships.

>> Those are there.

Those are the benefits that they're talking about.

>> When you have original Medicare you're paying your you have a no network scenario you can go to wherever you want to go.

>> There's no prior authorizations when you have an advantage plan.

The claims go to insurance companies.

They have networks.

They have prior authorizations that you have to work with.

It's a give and take and so the solicitations are for advantage plans both for people with or without Medicaid and some with if you're talking about a part B give back I get some of that money back in our area.

They're talking to people who are on Medicaid and they can get some of that money back.

But if you're not, you're really not going to get much of anything back because the plans we actually had a phone call about that last week.

>> Somebody said, you know, I hear them say and some of those commercials that I get one hundred and forty four dollars back is that what it says?

Yeah.

And and she wondered is that really true and should I apply for that?

>> And your answer was if she's on Medicaid.

Yes.

Now you say it was different in Florida.

Right?

There's some there's areas in the country where there are those types of plans that you don't need to be on on Medicaid.

They do have more of a give back program but not here but not here.

>> The competition down there is intense because of big senior population.

>> I'm sure it's so darned I guess what you're saying the answer is unless you're on Medicaid no, you don't have a chance in Indiana getting that money.

>> Exactly.

And listen carefully when you see those commercials because they're very careful about what they say they will use words like you might be eligible or you may receive or it's possible that so they're not giving you a guarantee.

>> And I think what's interesting to Greg, the word Medicare the word Medicare is up on the screen all the time so you can psychologically think oh, this is a Medicare commercial and it's really not it's coming from an insurance company.

>> So the number that you call well will not be Medicare.

>> It'll be the insurance company that you talk to.

Am I correct in all of that?

Yes, but sometimes it is a company that is soliciting leads to sell to insure companies show be careful when you when you call those because you might get more than one response to that phone call and be careful about giving any personal information.

>> Obviously you might get on a list that then is distributed as other leads OK in the Medicare book for twenty twenty two there's a section on covid obviously so many people have been affected one way or another by covid what does Medicare cover in terms of covid do they cover the vaccinations, do they cover treatment and is this going to apply for all twenty twenty two Greg as long as there isn't a national emergency OK everything is covered so everything's covered with the vaccinations and treatment.

>> OK, essentially once the that emergency is over you know that's up to discussion but right now they're covering it OK. >> All right.

And that's that's certainly comforting to know because I've heard people ask well how much does the vaccination cost or I can't afford it.

>> I'm not going to go get one so there's no cost.

>> There's no cost and you can go just about anywhere nowadays and get them.

Let me see some of the other sections that I'd like to talk about a little bit in terms of the the topics here.

>> How does one sign up for Medicare if they aren't on a chat when and how can you and how do you go about it?

>> If you receive Social Security you'll be automatically enrolled.

You receive your card three to two to three months prior to your birthday.

I know people have thrown that away.

You get a card get it's not the regular ten is kind of one of those those things Social Security got on the return envelope.

>> Keep those look at those because just a little paper color just not not the paper cards.

Yes.

Not elaborate at all but that's that's what we get.

>> Yeah.

And so if you are working you're not taking Social Security you will you can sign up online go to Medicare dot gov there's actually a button there that'll take you this week and apply online or you can call the Social Security office in your area and they can can help you you out and you know you'll need that Medicare card your little card that you get whenever you go to a physician, whether it's your family physician or a specialist or whatever, if it's the first time you've been there in the first time you're on Medicare, you need to show them that card.

They need that information as well, right?

>> Yeah.

We have a call coming in here.

Let's see who this is from.

And again, we're still here for several more minutes so you have a chance to get on the line and ask your questions.

>> OK, this is from Barbara.

Let's take one wait.

Let me wait.

I'm a little bit we do have phone lines that go into the control room.

We have a phone screen your back there.

His name is Jim by the way.

You can say to him and Jim will take your question and type it up and they send it out to me here in the studio or we can talk to you live on the air and we're happy to do that that way if Greg has any questions back to you, you can hear him and and he can hear you.

OK, well wait just a second here for the rest of Barbara's call to come in.

>> Meanwhile, Greg, you've started getting kind of busy since October 15th when this all started.

>> Yes.

What are the major concerns people are coming to you about?

Not really concerns.

>> Just plan checks.

Just check.

Yes, they do.

I need to make any changes.

Right.

All right then that's what we do.

We review the plans annually with folks so that they may come in with a different list of maybe they have a new medical situation.

>> They may come in with a new list of prescriptions they didn't have a year ago.

Right.

And then they might have the same prescription lists but the plans have changed enough that it makes sense exactly to make a change.

>> Exactly.

OK, and let me let me say something here just for what it's worth, people may get confused a little bit with agents changing plans.

We don't get paid any more.

>> People stay on a plan or we change it.

There's good you know, good is no economic incentive for an agent to change you unless he's changing you from another agent to himself.

>> But if you're staying the same agent, we don't get paid anymore.

So people ask you think about that.

Yeah, yeah.

If if you need to make a change.

Right.

OK, here's Barbara's question.

She said that she would like to know the difference between Advanta fewer days covered versus traditional Medicare.

One hundred days in covering nursing home care.

>> Yes, Barbara, it depends on the plan that you have.

>> Most of the advantage plans will will cover it about the same as original Medicare.

So in that the first twenty days are covered and then the next 80 days have a daily copay.

Now some of those plans will shorten that period of time.

In other words they'll come off twenty days and you'll have maybe twenty one to twenty five days that you have to pay and then once that is reached then you have the copay going forward part of it because all of these advantage plans have a maximum out of pocket.

>> You may hit it during this and any day stay which would then limit how much more you would have to pay with just the original Medicare there is no out-of-pocket limit to it so you would pay the 80 days plus and then after one hundred days Medicare no longer covers a stay because at that point they see figure it's chronic care instead of acute.

You're not getting better and so they're not covering it.

>> OK, that's important to know really is again give us the call here.

In fact we've got another call coming in right now from Marilyn.

I think Marilyn's on the line.

>> Is that right, Marilyn?

Are you listening to us right now?

Yes, I'm on the line.

>> Oh, thank you so much, Marilyn.

Thank you for watching.

What is your question for Greg ?

>> I remember at one point in the game if you got Social Security over like eighteen hundred that then you had to pay like one hundred and forty dollars a month for the Medicare and I'm wondering has that changed?

>> OK, great.

Can you help her at all.

No that hasn't changed the people who are not receiving low income assistance will have to pay the Part B premium.

Now how much of that premium just depends on the amount of assistance given.

>> If you're below a thousand dollars they'll pay all of it and then there's graduations between between the two .

>> OK.

Pretty simple answer no.

All right.

And Marilyn, thank you so much for watching us here on LIFE Ahead.

>> OK, let's go back to talking about some things people are curious about.

>> Are there any surprises?

Well, here's something that some people might be curious about and it's an interesting scenario when comes to advantage plans things new this year there's two plans that are there's some changes all all well which is owned by a company called Sonatine.

>> What's it called all?

Well, it's an advantage plan.

It's been around for a few years that no longer exists but it was taken over.

>> Centene purchased Whelk here which is a well known company and so all well plans are being merged into well care plans.

>> So that's the difference.

>> Another company called Pterosaurs had an advantage plan last year.

They have taken that one off the market and they're no longer offering it for next year.

Now care source is very big in the health insurance marketplace that's not changing but in Medicare the those plans are no longer going to be offered that actually offers an opportunity for anyone who's on that not only to switch to a different advantage plan but if they wanted to pick up a Medicare supplement they can without having to answer any health questions.

So it's an opportunity for those who are interested in doing that.

>> OK, that's good to know.

Now if a company no longer exists like the ones you were mentioning, will you be notified so you could choose something else?

>> Yes.

OK, so and then once you received that notification it's your responsibility then to make yes.

>> To sign up with another companies.

They will not change you.

Your coverage will end OK notice that and make a change.

So read the bulletins.

>> I know they're boring but read the bulletins.

Yeah you know sometimes we and we received so much mail and so much e-mail and so many texts that you know sometimes we don't know what to pay attention to and that's just a scam or what is just a lot of information if necessary to us.

>> Hey, one thing I want to mention before we get off the air, OK, and this was part of the big budget omnibus bill last year.

They put in their portion called the surprise no surprise act.

>> OK, this is going to be a good thing for anybody with health insurance.

>> No surprise no surprise that in fact I what I brought us just so I could have notes and oh and this is what's new.

>> This is new.

This starts January one.

So what happens is no no I should say non network charges cannot be billed for emergency services which is big because sometimes people go in there and they say they're out of network and they're not so insurance companies must keep their provider directories up to date and verify accuracy every 90 days plus they must respond within one day to consumers inquiring to providers network status so they got to let them know who's a network.

They must provide comparison tools both phone and Internet for customers and network providers so they can compare cost sharing amounts for coverage.

>> So the whole idea this is so you the consumer can get an idea how much something cost and the providers have to do this to not only the insurance companies but the providers have to give you an estimate of what's how much something is going to cost you and they have to the insurance companies have to give you an advance explanation of benefits within three days after asking it so this is good news and so just watch for that and don't be afraid to ask a provider next year how much does something cost and be inquisitive with this and they and they are expected to give you an exact amount.

Yes.

You know what you're getting in or if you're going in for a surgery or some sort of treatment.

Exactly.

Our time is always yes, he's here for half an hour.

>> It always feels like 12 or 15 minutes.

But you've shared a lot of new information and given a lot of valuable insight on Medicare and Advantage plans and everything around that.

>> So we really appreciate you very much.

Well, I appreciate the opportunity to come visit you every year and good luck surviving between now and December seven.

>> Yeah, the rest of you I thank you so much for watching us here on LIFE Ahead this Wednesday night.

And of course you can always catch LIFE Ahead on Wednesday nights at seven thirty right here on PBS Fort Wayne, good