 I'm too much more on medicine on the Think Tech live streaming network series broadcasting from our downtown studio at Pioneer Plaza in downtown Honolulu. I'm your host, Catherine Noor. Much more on medicine is an opportunity to learn about all aspects of healthcare. I talk with guests about medical and alternative care, treatment, insurance, medication, surgery, rehabilitation, prevention, and much more. Joining me in the studio is Martha Klopin to talk about the ABCs of Medicare. Martha spoke at one of our Honolulu Association of Insurance Professionals meetings, and I was so impressed that I asked her to speak with us today. Martha Klopin is the talk radio show host of a Medicare moment with Martha, which airs in Hawaii, or Salem Media Group, on AM 690 and 94.3 FM. Martha also produces and hosts a Medicare program on Olalo Community Television. She has more than 30 years of experience in the financial services and insurance industry, and is a graduate of New York University. She has worked for several local health insurance companies, including HMSA and Aloha Care. Aloha, Martha. Aloha. Thanks so much for having me here. Well, I am really interested in learning all about Medicare today, and I have a lot of questions. So, first of all, what is Medicare? Excellent question. The perfect place to start. Medicare started way back in the 60s. 1965 is when it was actually signed into law. In 1966, the first Medicare cards went out. Prior to that, if you retired from your company, you didn't have any insurance. So Medicare is a very valuable program for people who retire from work, no longer have coverage and qualify. Okay. So, I hear these words like Medicare and Medicaid. What are the, is there a difference between Medicare and Medicaid? Yes, a pretty big difference. Medicare is a federal government program that takes away from every paycheck, deducts a certain amount from your pay that goes into the Medicare insurance program. Medicaid is generally run by states with some assistance from the government that basically is there for you if your income falls below a certain level. So Medicare cares for you because through every paycheck you've been caring for Medicare and Medicaid aids you if you happen to find yourself in a situation that you don't have enough money to pay for insurance, sort of a safety net. Okay. So are there different kinds of Medicare? Well, that's a good question. The basic or traditional Medicare that was signed into law back in the 60s consists of Medicare Part A and Medicare Part B. The Part A takes care of hospital insurance and things like that. Part B takes care of your doctor visits, lab work, things of that nature. So Medicare Part A and B were the first to be offered to the public if they qualify and later on in the 80s there were programs offered by private insurance companies who have a contract with Medicare to offer additional options to go along with your Medicare. Okay. So I have, I actually, I'll tell you my situation, maybe you can tell me what I do. Okay. So I'm not 65 right now and there's a number of years before that will happen and I have my own business. I'm a lawyer and I have my own practice but only a few people working at my practice. Okay. And I hope I'm telling you all the relevant information. Okay. So I have my own insurance and it's a PPO and so what would you advise me to do in relation to Medicare? Like what, what, what is my situation? I'm really glad that you asked that question because especially a lot of independent attorneys, CPAs, realtors, anyone who has their own business with less than 20 employees may be required to sign up for their Medicare Part A and Medicare Part B when they turn 65. And if they do not, there may be penalties and other situations that you want to avoid. I've got to tell you a quick story. Please. I have a gentleman call me up and he said, Martha, I was referred to you by the Keimel Key High School graduating class of 1969. So I said, okay. And he said, you know what's a bad day, Martha? And I said, oh, tell me, what's a bad day? He said, I had an accident and I'm paralyzed from the neck down and I'm at Queen's Hospital. I said, sir, that sounds like a really, really bad day. He said, nope, that's not the bad part. I said, it's not. He said, I'm at Queen's Hospital and the financial representative just came in and told me that even though I'm working and I have employer coverage because I'm self-employed, independent, just me, no other employees, I was supposed to sign up for my Medicare at age 65 and as a result, Medicare is primary and since I don't have Medicare, I never signed up for my A or B, my employer coverage does not have to pay. So to date, I've racked up $150,000 worth of expenses. Can you come by and help me sign up for this A and B? And Catherine, I rushed right over and assisted him. Well, are you wearing a cape? No, but I was a fan of the flying nun. So Sister Patril, I was flying it. Oh my goodness. Wow. He was very, very thankful. Very thankful. Okay, so now you seem very excited about Medicare. Yes. So what about this? Tell us about why you're involved in this business. Well, Catherine, I started out on Wall Street. You can believe that. Out in New York City and I relocated here and got into, was working for a trust company and had many trust clients and investment clients and I noticed that as they got older, a lot of dollars were going out in copays for health insurance and different things that they needed and I was thinking they did such a good job saving money, but why does so much money have to go when you're retired and you have health care costs? So I was just very intrigued and I had an opportunity to work at HMSA and get into the health care space and I learned that you have to make good decisions when you're transitioning to Medicare because if you don't make the right decisions, it could impact that nice nest egg that you put away. So earlier you asked me in your situation, if you continue to be independent, when you reach that magical age of 65, you will need to definitely contact Social Security and explore enrolling into your Medicare Part A and B to make sure you don't end up like the gentleman at Queen. Well, hopefully I won't, but let me ask you. Okay, let's say that I'm busy and I don't get around to enrolling on time. Okay, let me, well, let me first ask you. My birthday is in December. When do I have to enroll? Right. For Medicare, original Medicare, if you are required to enroll at age 65, you have a period that begins three months before your 65th birthday, the month of your 65th birthday and up to three months after your 65th birthday. But because you don't want any gaps in coverage, of course you would want to do it the month before your 65th birthday, so it'll take effect the month you turn 65. Okay, so if I don't do it, do I get penalized or put in like Medicare prison? Well, they haven't set up a prison yet as far as I know. That could be in the future. But there is a period of time that you would not be allowed to enroll until what's called a general enrollment period. That's another period that starts in January, ends in March, and doesn't become effective your insurance until July. So if you miss your enrollment period that three months before your 65th month of or three months after, you could end up in that general enrollment period. But there is no one-size-fits-all in Medicare. I share that a lot. If you're employed, even if you're turning 65, if the company has more than 20, you may not be required to enroll in Medicare. You may have a special enrollment period. So that's why you can't really take any information without really speaking to someone who's knowledgeable, calling Social Security, talking to your human resources folks. You really have to gather information before you start making decisions. Okay, so I understand that when I called you to appear on the show today that there was something special coming up that made this a very timely presentation. What is that? Yes, it's something that happens every year. It's called Medicare Open Enrollment Period, and that's the period when people who are existing Medicare beneficiaries who've had a Medicare plan can look at the plans coming forth for 2020. And they can enroll in them if they want. So that's the period of time when people can change plans. So it begins October 15th, and it ends December 7th. So if somebody is interested in looking at new options or looking at changing plans for 2020, that's the period that they get to do it unless they have a special enrollment period. So I guess how people can remember that is that it's the season around Halloween and Thanksgiving that is that open enrollment period. Is that right? That's correct. So that they, while they're eating their grandchildren's Halloween candy and planning their menu for Thanksgiving, they can also think about open enrollment for Medicare, correct? That's exactly, and that would be for people who have a plan and are looking to see what's new for 2020 and may want to change plans. Sometimes people get confused if they have a birthday in October, November, or December. They think that's the only time they can enroll, but they have a different enrollment period because they're turning 65. So that open enrollment period is intended for people who already have Medicare and are looking to maybe change plans for the new year. Okay. Now, if I am with a company that like I'm 65 years old or about to turn 65 years old and I'm with a company that's more than 20 people, is that any different? Yes, that can be different because you may be able to delay enrolling in Medicare because of the employer plan. However, like I said, no one size fits all. There are many city, state employees in Hawaii and they may have another benefit through what's called the Employer Union Trust Fund. And if you have retiree insurance benefits that are waiting for you, they will require you to sign up for Medicare Part A and B at age 65. It's actually in the Hawaii Revised Statutes. So again, that's what makes it a little bit confusing. If you happen to be turning 65, you work for a company that has more than 20, you may be able to delay enrolling in Medicare. However, if you have this other benefit through the Hawaii retiree system, then they do require you to get A and B. So no one size fits all. Okay. So if anyone ever says, oh, it works like this, maybe you shouldn't really believe them unless your name is Martha Klopin. Right. Because no one size fits all. That's the best way I can express it. I've seen so many different situations. Even federal retirees have a different set of rules that they follow. Wow. So I'm thinking that I should mark on my calendar that maybe about four or five months before I turn 65 so that I can start the ball rolling and that maybe other people do that as well. Absolutely. To start educating yourself about Medicare basics. Absolutely. Four to five months is a good idea. And then if you need to enroll, you can do that as early as three months before your 65th birthday. Oh, okay. Well, gosh, I'm learning so much. And I think that now, I think that everyone in my class from high school, we just had our class reunion. As we turn 65, we might have to, you know, put on Facebook or something like remember to enroll in Medicare to our classmates. So, okay. So we're going to take a short break. I'm Catherine Norr. This is much more on medicine on the think tech live streaming network series. We're talking with Martha Klopin about the ABCs of Medicare. I'm Richard Amri, one of the co-hosts with Kondo Insider, sitting next to my other co-host, Jane Sugimura. We're very pleased to be on Think Tech Hawaii and provide this show of education, news, and topics affecting living in an association. About 38% of our population lives in an association and you have very specific needs and rules to make an effective pairing of your home. So we're glad to be a part of this show. And what do you think, Jane? And yes, we're very proud to be part of this program. And what we want to do is to bring to all of the people who are involved with Kondo, especially people sitting on the boards and the owners, topics that will assist them in governing their projects and dealing with issues that, you know, that boards and owners have to deal with on a day-to-day basis. Our show is every Thursday at 3 o'clock. We hope you watch it and always feel free to send in topics for discussion. Aloha. Aloha. We're back. We're live. I'm Catherine Noor, and this is Much More on Medicine on the Think Tech live streaming network series. And we're talking with Martha Klopin about the ABCs of Medicare. All right, Martha. Following up on what we were talking about before, how many Medicare beneficiaries are there in Hawaii? Catherine, there are over 280,000 Medicare beneficiaries in Hawaii. So I hope people will really go out and start to learn as much as they can about Medicare because probably people you know have Medicare and they probably have questions. Oh, okay. So we're talking about the entire population of the outer islands, essentially, right? That's right. Okay. So, and is there something called original Medicare? Yes. Refer to as original Medicare or traditional Medicare. That's the part A and part B. So when you enroll, that's what you're enrolling in through social security. It starts with social security, the eligibility process. But in 2006, part D as a drug came along. So now there's a part D drug plan that people are required to get as well. So part A and B are original Medicare. Part D came along in 2006. Okay. And so now does it cover medication? Part D does cover medication. Okay. Now, would that include over-the-counter medication or only prescription medication? Only prescription medications. Okay. Part D. All right. And you know, there's an issue. I don't know if you know the answer to this, but I'm going to throw it out there. Okay. Okay. There's an issue in healthcare where physicians actually fill prescriptions in their office. And I'm wondering if you know whether Medicare would pay for prescriptions filled in a doctor's office versus a pharmacy or whether there's any difference. Yes. There are actually some drugs covered under part B as in boy of Medicare. And if they are administered in the physician's office and it's something that is approved by Medicare, that would be covered. But it would be covered under part B as in boy, as opposed to the part D that the doctor has written you a prescription and you picked up yourself. I had a gentleman and he was on a medication that was $8,000 every two weeks. Oh. $8,000 every two weeks. So he was able to get this medication from his doctor's office. So he was very concerned when he was transitioning from the employer plan to Medicare. Because he was thinking if a prescription is written and I have to pick it up from the drugstore, what might the cost be under part D? But it turns out that he was covered for this prescription under part B as in boy. It was administered in his doctor's office and it reduced his out-of-pocket considerably. And do you know if compound prescriptions are covered? Well, it all depends on what Medicare covers because when you transition to Medicare, Medicare has medications that they approve or the insurance company that covers your plan approves. So under a part B, something given in the doctor's office, that would be between the doctor and Medicare. So the doctor would have to get authorization for certain medications. Now when you say that someone has a prescription that they need and it might cost $8,000 every two weeks, and that would be $16,000. That's right. And most people that are 65 and over don't have $65,000 a month to pay for that necessary prescription, let alone pay for everything else they need, housing and food. And so obviously this is a really big financial planning issue, right? Exactly. That people have not prepared for and even financial advisors like myself, remember how did I get into this field? I was shocked to find out that your co-pays, co-insurance and medications could be so expensive when it's time for retirement. Sure. And even basic drugs, I've noticed like an over-the-counter nexium is very expensive because I think that can be $20 to $40. And it's not $8,000, but it's kind of expensive for most people. Absolutely. So does enrolling in Medicare have a cost? Yes. Enrolling in Medicare does have a cost. There's a cost for the Part B as in Boy. The standard cost for 2019 is $135.50 per month. Okay. $135.50. However, it is income-adjusted. So if your income is higher, your premium will be higher. So that's another little thing people aren't expecting. And I've met some physicians and some attorneys actually who end up paying hundreds of dollars for their Medicare Part B and they tell me, Martha, I read that it was $135.50. And I said, well, there's another little section to read, income-adjusted. So there's income-related adjustments to your Medicare payment. Oh, my gosh. That sounds so low compared to my monthly payment for my PPO, which is ridiculous. Oh, yeah. It seems to raise every month. It seems to increase. Does once you're paying your Medicare per month, does it change per month? Does it increase or how does that work? Well, there's two components to Medicare. There's the original Medicare, which you need in order to join other Medicare options. So that will depend on what the other insurance companies may be charging. And if you decide to pick up additional coverage to work alongside of your Medicare or in place of. So hard to say until you decide which Medicare option that you may select. But the most important thing to understand is that there are costs when you transition to Medicare for the Medicare premiums or end-door supplement plans that you may pick up. And for people who do not meet the eligibility requirements, you need to work for at least 10 years or 40 quarters who actually can buy into Medicare. The costs for Medicare Part A, which most people who met the requirements get for free, is about $400. And the Medicare Part B, as I said, is $135.50 in 2019 if it's not adjusted. So you can actually pick up Medicare. You can pay for it if you don't have enough work credits to qualify. Okay. And now that we're talking about costs, you mentioned about that gentleman that was in the hospital and he hadn't signed up and his primary carrier wasn't going to pay. Now, signing up late, is there a penalty? I mean, we mentioned there's no Medicare prison, but is there a penalty? Well, yes, there can be. And I do know some people who are paying them. But I got a call a year or so ago from a gentleman and he called me and he said, Martha, I heard about you. And he said, people tell me you'd be able to answer these questions. I said, oh, what's the question? He said, I'm being told that my penalty, the sign up for Medicare Part B, is $10,000. That's like, that's a lot. Let me check on that. So I explored a little bit more. It turned out this gentleman had been incarcerated for five years. And when you're incarcerated, you don't get your social security payment. So his Medicare Part B premium was coming out of his social security check. So when he no longer had that payment, he was no longer paying in the system. So social security was asking him to pay back the five years plus a penalty of 10% for each year that he should have stayed in the program but was not. So 50% of that Part B premium. So we found a way to kind of work around that and he was actually given equitable relief and they waived the 10,000. But yes, it can be very expensive if you miss these deadlines or you don't do what you're supposed to do. Okay. So if I go to the doctor and I have Medicare, okay, so I have a few questions related to that. Sure. First of all, are there doctors that don't take Medicare? There are doctors who can decide that they don't want to take Medicare and they are not registered with Medicare. So yes, there are some doctors who do not take Medicare. In Hawaii, the last numbers I've seen about 71% do take Medicare. Okay. And that would include your family doctor. Family doctor, specialists, APRNs. Okay. Are there any specialists, types of specialties where it's very hard to get treatment from because they don't take Medicare? I'm not aware of any. I'm not aware. Okay. I'm not aware. And when you go to a doctor and you have Medicare, do you have a copay? It depends on the type of plan that you choose. If you just stuck with original Medicare, Medicare Part B takes care of doctor visits. So Medicare would pay 80% and you would be responsible for 20% of that cost. But there are other programs that you could pick up that may reduce that co-share or co-adjustments. Okay. My head is spinning. This is so, like, there's so much information. So there's, what type of person, I mean, what type of professional helps people with Medicare issues? Well, that's a good question. Medicare issues, you are asked to go to 1-800-MEDICARE and talk to someone on the phone. There is no official office for Medicare here. So if you have a Medicare issue, you have a plan, you've talked to the insurance company, you're having some issues, you would call 1-800-MEDICARE. Okay. And what resources can you lead people to answer their questions regarding Medicare? I would say for people transitioning to Medicare due to age or disability as well, you should call Social Security Administration. That's where you start. And then later on, once you have Medicare, if you have issues, you can call 1-800-MEDICARE. So those are the best resources. It's the contact Social Security directly, because again, there's no one size that fits all. There's no one size. So you need to give them your information to look up your record and they'll be able to tell you what you need to do and when. And then Medicare, once you have Medicare, if you have some issue that your insurance company is not handling it, you can call Medicare directly. Martha, it's been wonderful learning about Medicare from you today, and we really appreciate all of the wisdom you've given us and advised. So we're out of time and we'll have to wrap it up. I'm Catherine Norr. This is Much More On Medicine on the ThinkTech Live Spimming Network series. We've been talking with Martha Klopin about the ABCs of Medicare. Thank you for joining us today. Thanks to our broadcast engineer, our floor manager, and to Jay Fidel, our executive producer who puts it all together. Please join us for future ThinkTech production.