Episode 1: The Rise Options and Pitfalls of Open Enrollment With Andrew Vasta
Transcript: Shana Siegel, Andrew Vasta
Welcome to Norris McLaughlin’s Aging Answers a limited podcast series discussing the key topics of elder law planning and long-term care. I’m your host, Shanna Siegel, Practice Group, leader of the Elder Law Group, and member at Norris McLaughlin. In this episode, I’m joined by Medicare broker Andrew Vasta to talk about the options and pitfalls of navigating Medicare enrollment. Hi Andrew. How are you?
Hey, good to see you, Shana.
You too. So, we’re about to enter your busy season Medicare open enrollment season. Can you tell us what this means and why it’s important for Medicare beneficiaries?
Yeah, so Medicare open enrollment season is where you get bombarded by advertisements all day. What it is, is the time that you can change from one plan to another. It’s October 15th to December 7th, so the updated plans will come out October 1st. So the 2023 plans, and during that time, people’s premiums on their plans, so the monthly fee if they pay for their insurance changes. The prescriptions that are covered by drug plans change, how much medications costs change, and what network restrictions there are can update. So, there’s a lot that goes into it, but take a look every year, whatever insurance policy Medicare beneficiary has, you get a letter saying all the changes from 2022 to 2023 called an ANOC or Annual Notice of Change. And in there it explains everything. So sometimes it makes sense just to keep the same coverage, but other times the premium might be doubling in price. So, it does make sense to review your coverage during this time and just see if it’s a good fit for 2023.
So, I know a lot of my clients seem to be kind of overwhelmed with this. They’re getting, as you said, like a ton of mail. They don’t know whether to change. They don’t know whether you know they’ve got a good deal or not. So how can someone like yourself help them?
Yeah, so there’s, there’s no charge to work with a broker, and we represent all different carriers and help people shop the market. So, on Medicare’s website, medicare.gov. We work with that website and people at their home computer can do so you can put in your medications and it will tell you what plans will cover them best. And an expert like myself, can really help you navigate all the different plan options because each carrier will send you the benefits to their plans, but not the drawback. And all the advertisements you see all day, say, Get this and that, and the other thing. But they don’t tell you that there might be a limited network or there might be more out-of-pocket expenses as you use the coverage. So, talking to an expert, there’s no charge number one. They should be unbiased and just help you figure this all out and represent multiple carriers. But it just gives you clarity and they can put it into plain english, so you understand what you’re getting.
I know one of the things that was really confusing for people are the Medicare Advantage Plan.
So, they generally have a lot of better coverage in some ways because they’ll cover other stuff.
But I know that when I’m working with clients there can be a lot of disadvantages of that. So, can you just talk a little bit about Medicare Advantage plans and pros and cons and how you might advise people depending on their illness?
Yeah, So Medicare has multiple parts to it. Medicare Part C is Medicare Advantage. And with Medicare Advantage, you still have to pay for Medicare, uh, what you get from the government, Medicare part A and B. But the way it works is the government then contracts with a private insurance company, and that company then takes over the risk of insuring you. So, if you went with one of the major carriers, United Healthcare, Aetna, Blue Cross Blue Shield, that insurance company would then become your Medicare cover. So, you’d get all your insurance through that Medicare Advantage plan, and you’d present that card at the doctor, the hospital, and the pharmacy. You’re not technically giving up Medicare. You still have it, but you’re getting your Medicare through them. The benefits are that there’s a lot of plans that are very low monthly fee. Some plans are no monthly fee. They include extra perks with a lot of the options such as dental and vision, hearing aid benefits and gym memberships. So it, it makes sense for a lot of people because they don’t have to pay an extra amount out of pocket, uh, per month and they get these extra benefits that you don’t get with original Medicare through the red, white, and blue card. The downside is that it, they are HMO or PPO networks in New Jersey. So, with these plans you have to see doctors and hospitals who take them. and they’re more pay as you go. So, every time you’re going to the doctor or going to the hospital, it does have copays and each plan’s copays will be different based on, what plans are you are enrolled in and what’s available in your area. So, it can be very beneficial if you’re healthy or if you do have a major health event, you can end up spending more money out of pocket than you would’ve with a different coverage. So, there’s pluses and minuses and there are restrictions of when you can enroll in and out of the coverage. So, this is the time where you can either enroll into the or it’s about to be the time where you can enroll into a Medicare Advantage plan or out of an advantage plan, and it would start January 1st with your new coverage.
So, one of the things I think is a little bit of a myth that I’ve even, you know, met a lot of attorneys who fall into is that, well, you can do Medicare Advantage when you’re healthy and then you can just switch over. Right? But you know, we are talking about it and you pointed out, no, that can be a real problem because you might not be able to get your supplemental plan. So, can you talk about that a little bit?
Yeah. Good, Good question. It depends on the state that you’re in. So, in New Jersey, which is where I specifically work, you have a, when you first qualify for Medicare, you have six months to take a Medicare supplement plan. Which is the other type of Medicare, where Medicare is your primary, you can add on a supplement and a separate drug plan. Or you can go to the Medicare Advantage route. So if you go to the Medicare Advantage route and you wanna switch to a supplement in the future in New Jersey, you’d have to answer health underwriting questions typically and can be denied based on your health. They ask if anything major is going on with your health, with your heart, lungs, kidneys, et cetera. I mean, typically within the last two years, they can deny you. Or they can accept you, but at a higher price, if you are a smoker, you could get accepted but at a higher price. So, when you’re first qualifying for Medicare, make sure you’re thinking long-term about this decision because in the future if something does happen with your health, you could be unable to switch your coverage.
And I’ve definitely found that with some clients where they wanna go into a rehab facility and it’s, you know, there’s not good coverage by their Medicare advantage. They end up switching to traditional Medicare and then they can’t get a supplement, which you know, they’re okay. So, they’re with traditional Medicare, and that’s, you know, at least now they can be in the facility and use the doctors, but they’re, they’re missing that supplement piece, so.
There’s no maximum that you can end up spending with a medic, just original Medicare, so.
It can get costly.
Yeah, no, absolutely. I’m sure you see all kinds of situations like that, but other, you know, issues that come up with clients with Medicare mistakes, misunderstandings. Do you wanna talk a little bit about some of those?
Sure. Yeah. So there’s a number of different, like loopholes, as I could call them, that people fall. But some of the more popular ones is, if somebody’s working past age 65 and they are losing their employer coverage and are offered Cobra, some people think that they can take Cobra instead of Medicare and not take Medicare until technically of eight months to apply for Medicare and take Cobra for those eight months. Cobra would be secondary insurance to Medicare, so you can’t do that because you don’t have any primary insurance if you don’t take Medicare. So that’s one thing. If you do are over age 65 and are offered Cobra, you can’t go into Cobra. Other situations are with veterans. If you’re a veteran and use the VA, you can do that and get your prescriptions through that. But it’s also important, again, to take Medicare when you’re first eligible for it because if you don’t take Medicare A and B, even though you plan on using the VA, things happen and you never know if that’s not gonna be available to you in the future. And then you can’t get Medicare, part B in the future except for a certain timeframe. So, it’s if you’re,
And there’s a penalty. Right?
And there’s a penalty as well. And they, you can get very costly if you don’t take it when you’re first eligible. So, if somebody is a veteran and they plan to just use the VA, They can do that, but I just advise you to take Medicare A and B as well just in case. Just to have a backup to the VA and other just things that people think that if you’re still working after age 65, as long as your employer is, or your spouse’s employer is above 20 employees and you get your insurance through them, you can delay Medicare until you are losing that employer coverage. At that point, you can apply for Medicare without any penalty whenever that situation happens. So there’s know, there’s a lot of misconception about that, but you can do that. The only exception is if your insurance through work is an employer of less than 20 employees, then you do have to take Medicare. So, as I said, a lot of nuances, but it’s, that’s why it’s important to speak with a professional.
Yeah. And you could help somebody with those kinds of issues as well.
Not just during the open enrollment season, but any of those other kind of unusual things that happened.
If they’re thinking about a move off of lower coverage or anything like that.
Yes, of course. And people are always retiring all year and turning 65 all year round, so Absolutely.
Right, So you can help people with that initial choice.
In terms of doing that as well.
Yeah, and if you move out of state, then you have to change your coverage as well. So, there’s what’s called special election periods where you can change mid-year if you have one of those.
Okay. If you do end up in a Medicare Advantage plan and you decide that you want to get out of that plan, I, think you mentioned that there are timeframes where you can potentially either move to a different Medicare advantage or change back to traditional Medicare. Is that the same period or is that a different period?
That is the same period, yes. So, October 15th through December 7th is the annual election period, and during this time, you can change for a start of, January 1st. There is also a period from January 1st to the end of February where if you’re on an advantage plan and you wanna switch to a different option, you can do that during that timeframe too. There are restrictions of what you can do during that timeframe. So, October 15th into December 7th is kind of like a open playing field with where you can go from one plan to another, but the, as I said before, the only restriction is getting a supplement plan, and those plans can ask the health underwriting questions. So just make sure that you qualified are, and are accepted to that new plan before you dis-enroll from your old plan.
Got it. Okay. Anything else we should know?
Just verify as though we were talking about in the beginning. People’s medications change every year and verify that the plan that you have is going to cover them and at the lowest cost for the upcoming year. Because I’ve seen plans that will cover medication one year and then won’t cover it all the next year. There’s plans that are more than doubling in price for 2023. So, it is important to at least just take a look and verify that you’re still in a good coverage. A lot of the times. As I said, it makes sense just to keep your plan as is and you don’t have to do anything. And all these advertisements, they’ll be on tv, but you don’t have to pay attention to them because they will, they’re just trying to switch you to their plan. But it is good just to check. So, verify that you’re on the correct coverage. And then as I said, brokers, there’s no charge to work with us, so we help people every day with this stuff.
Yeah. You were telling me about a client that you saved like thousands of dollars.
Oh, absolutely. Yeah.
In terms of some change that was happening with their plan.
All the time. Yeah. It’s incredible how one plan will say that this medication is $5,000 a year, and another plan might say it’s $500 a year. So, it can be drastic changes, in the cost of medications.
Wow, all right. Well, thank you very much, Andrew.
Yeah, of course. Thank you.
All right. This has been Norris McLaughlin’s Aging Answers a limited podcast series discussing the important topics revolving around elder law planning and long-term care. I wanna thank my guest, Andrew Vasta, and you the listener for being a part of our conversation. Be sure to tune in next time for a brand-new episode. If you’d like to learn about our work, please email me at aging firstname.lastname@example.org.