 Welcome to the latest edition of Telehealth in Hawaii. I'm your host, Vikram Acharya. I'm the Chief Executive Officer of Cloud Well Health, an all virtual telemedicine provider based in Hawaii. We have a very exciting show for you today, a very educational show for you today. We have my colleague, Curtis Yee. Curtis Yee is the Operations Manager at Premier Benefit Consultants located in Hawaii. How are you doing today, Curtis? I'm doing great, Vikram. How about yourself? I'm doing good. I'm doing good. Thanks a ton for being on. This is gonna be a real good one. Awesome. I look forward to it. Thank you very much for having me on and representing Premier Benefit Consultants Day. Oh, you're most welcome. To get things started, Curtis, tell me a little bit about yourself. Where you're from, we'll got you into working as a broker. We'll go from there. Okay, yeah. It's kind of a funny story. Back in 2000, well, I'll just go back. I actually got my health and life insurance license in the 1990s. And honestly, I didn't really care doing life insurance. So I got out of that. And then in 2005, I got a call from a friend of mine who was in the life insurance business that told me, hey, Kurt, get your license again. We're gonna do Medicare. And I was like, what's Medicare? I didn't even know what it was, right? So I trusted him. So I got my license and that started me down this path in 2006 as a broker representing companies that provide Medicare Advantage plans. And here we are today in 2022 and it's been a great journey helping our seniors and people on disability, maximizing the plans that are out there and that's available to them. And it's been great. And a little bit about myself. Born and raised in Hawaii, grew up in Makakilo, which eventually turned into Kapolei and very happily married for 29 years. I have two sons and two grandchildren. But yeah, that's just a little bit about myself. Excellent, excellent. Curtis, you hear in the news about Medicare Advantage, can you break these down for us for people who may not know? What are the different types of Medicare options available to people over the age of 65 perhaps? Sure, really there's two options that Medicare beneficiaries can go with. The first option would be a Medicare supplement plan. So a Medicare supplement plan is actually a secondary insurance to original Medicare. So, original Medicare is actually a insurance program, a fee for service that has deductibles. And it's basically 80, 20 plan with Medicare picking up 80% of the cost and the beneficiary paying the 20%. And if you were to purchase a supplement plan or also known as Medigap plans, it fills in the costs or pays the cost that Medicare doesn't cover. These plans are, they do have a premium and they do provide great coverage. Plan G, for example, if somebody enrolls in it, they will just pay the Medicare Part B deductible, which this year is 233, but any other Medicare covered services, they would have a zero copayment. The plans do not cover their drugs. So we would help somebody get onto what's called a standalone prescription drug plan that would cover their medications. And then the other option, which is very popular in Hawaii are Medicare Advantage plans. And you can kind of think of a, it's like a all-in-one medical plan that's provided through a private health insurance company, you know, like HMSA or Kaiser, UnitedHealthcare is just to name a few. And basically they cover your inpatient, outpatient medical services and they do cover your drugs. Most of them cover your drugs. These plans started what we call zero premium. And when I first got into business, it was pretty funny when I would do appointments and I would tell people that there's no cost to the plan. They would basically kick me out of the housing. There's no way you're trying to rip me off somehow. But in reality, the federal government will pay the insurance carriers to manage your plans. And basically they have to cover everything that Medicare covers. They provide some additional benefits like dental vision, gym membership. And again, they cover your medications. And for those people that don't need a medication or a drug plan, there are what's called MA only plans also available for people that are, say, tri-care or VA beneficiaries that pick up their medications to tri-care the VA. And there are just Medicare advantage medical plans only also available for them. Excellent. Now, you said that Medicare advantage plans are popular in Hawaii. Why is that? I think because these plans started a zero premium and a lot of times the beneficiaries are looking for the additional benefits that original Medicare doesn't cover. So if somebody were to enroll in a supplement plan, basically original Medicare is their primary. Original Medicare doesn't cover vision benefits. The only time they do cover glasses is after cataract surgery. And then when it comes to dental, there's no dental plan coverage whatsoever under original Medicare. So when you look at a Medicare advantage plan, cost-wise they're gonna start off cheaper in a sense that they start at a zero premium, meaning that the Medicare beneficiary still has to pay their Part B premium. Everybody has to pay that to have Medicare's A and B. But the plans would not charge you anything above and beyond what social security charge for Part B. And you have reasonable out-of-pocket costs. For 2023, majority of the plans have a zero co-payment for their primary care doctors. For those people using telehealth, it's a zero co-payment. Specialists probably range around $30, $40. And then they do get those additional benefits, dental coverage. Some of the plans have up to $3,000 in additional dental. They cover up to $300 in vision benefits for your annual eye exam. And if you need either glasses or contacts, gym memberships where they can go to the YMCA, 24-hour fitness, things like that. And chiropractor and acupuncture. So some holistic type medicine is also available on those plans. And I think the other thing too is that being on an island and we're isolated, I noticed in the mainland a lot of times people do go on supplement plans because they may travel more or there's no birds and they need to, they're gonna go from say the East, the Northeast to like Florida or somewhere down South. And I would say in that situation, supplement plans are a little more easy to use. But they're more user friendly because there's no network with original Medicare. So I think if you take all that together, majority of people in Hawaii do wanna be on a Medicare Advantage plan. It sounds like the Medicare Advantage plans are more comprehensive. Yes, they definitely are. Yeah. Now, if I'm over the age of 65 and I have pension coverage, a benefit plan, let's just say UnitedHealthcare, can I still get Medicare or Medicare Advantage as a supplement to my pension insurance? If you're retired and you're getting employer retirement benefits, especially if it's through a union, I'll say that. If it's through a union, then I'd be very cautious. I would always tell people to call their plan administrator because union plans and retirement, they do actually get some money from the federal government to help with the plans. And you can only be on one plan that gets federal subsidies. And so if somebody were to enroll in a Medicare Advantage plan, then there's a great possibility that they'll get disenrolled from their union plan. And we don't wanna ever take somebody off their union plan. So we're very cautious when it comes to people that have union, especially union benefits, that we would wanna talk to their plan administrator. And I'll be honest, most likely, they wouldn't wanna be on a Medicare Advantage plan. Now, the one exception to the rule would be federal government employees. They will have a retirement plan that actually works with Medicare Advantage plans. And in retirement, the Medicare plan will be the primary and their employment plan, employer plan will be the secondary plan. Got it, that's very helpful. Now, if I have a menu of Medicare Advantage plans, I can choose, what kinds of criteria should I look at if I wanna make the best choice for me and my family when it comes to, what are some of the main things to look at? So I would say the most important thing to look at would be the doctors that you see on a regular basis and the medications you cover. So whenever I meet with somebody and I'm gonna do a needs assessment, the first thing I do is I take a look at their doctors, make sure that they're in network with the plan. And then I take a look at the medications and check the formulary to make sure that the plan does cover their medications. And then after that, then we kinda take a look at the bells and whistles of the plan to see if dental is important to them. Another thing is if they travel or maybe stay in the mainland for a while, choosing a PPO plan that has a network in the mainland may be very important to them. So that's really, I would say the core of it though is that you wanna take a look at the doctors and medications and make sure that that plan is gonna cover all of it and is cost-effective for the beneficiary. Yeah. Now there's a lot in the news about hospital pricing, transparency, people getting unexpected bills in the mail. What advice can you give to people when they're in this situation? I have this bill. I thought it covered more than what it did. I can't understand it. What advice would you give to people who are in this situation? So with people that receive a bill and they don't think that that's a correct bill, what they do is there is an appeals process that every Medicare Advantage plan has to offer to their beneficiary. So you would wanna call as soon as possible customer service and then you can file the appeal and then the plan has to research that bill to make sure that everything is correct and then report back to you on what their findings were. And then I think another important thing is just understanding your benefits when you do enroll. When it comes to say like inpatient hospitalization, most of these plans will actually, for a set amount of days, and I'll give you an example for 2023 UnitedHealthcare, it's 395 per day for the first four days. And then it says zero thereafter for unlimited time in the hospital. So you wanna take a look at the plan to understand, so if you're in for one day, you're gonna pay 395. If you're in for two days, basically this could be about 800 or 790. So understanding your plan benefits and what the costs are would be the first step. And again, if you disagree with what they are, then you should do that appeals process and call customer service. And they do actually have three days, I believe to respond back to you if you do submit the appeal to acknowledge that what they're doing as far as working on it. Yeah, so there are specific channels that beneficiaries can pursue to address their concerns. That's good to know. There are. Yeah. Now, we're across the country. There's an important period of time right now. It's called open enrollment. And it's right around the corner. It's a busy time for folks like yourself, especially during open enrollment. What exactly is open enrollment? And what is the role of someone like yourself during this process? So real fast though, actually Medicare calls it annual enrollment. They confuse everybody because they do have an open enrollment. Okay? No, they do. So the annual enrollment period starts on October 15th and it goes to December 7th. So during this timeframe, anybody that's on Medicare can change their plans and they can change their plan as many times as they want to. It's just whatever they sign and date last will start on January 1st of the following year. And so now is the time for beneficiaries to go ahead and take a look at what's available for 2023. If they want, they can definitely give us a call and we do free reviews for people of their plans for what they have this year, what it's gonna be like for next year. So it's incredibly busy for us. We're doing a lot of events at all the different retail outlets. We're doing formal presentations at hotels or restaurants to get the word out. But right now is the time for all of you that have Medicare to take a look at what's going on in 2023 and then go ahead and make sure you're on the right plan. And this is the time to do it. So October 15th is when you can start enrolling into a plan and that'll end on December 7th. And then since you brought it up, I'll speak a little bit about open enrollment. So open enrollment actually is the first quarter of the year. So from January to March, Medicare allows anybody on a Medicare Advantage plan to make a change. I would basically say it's kind of like a buyer's remorse period or I didn't do what I needed to do during annual enrollment and I'm on a Medicare Advantage plan. And so they allow them to make one change. Unlike annual enrollment where you can make multiple changes during open enrollment, if you're on a Medicare Advantage plan, you can either decide to go back to original Medicare or maybe get a supplement plan and a prescription drug plan or you can change to another Medicare Advantage plan. And the difference is that if I change in January, my plan will start February, if I change in February, March, and if I change in March, it'll start in April. That would be open enrollment. Okay. So it sounds like there's two sequences. Number one, the one that's about to start now. Yes. And then one for people who are signing up for the first time in the beginning of the year and that is a different track then. Yeah, so the one in the beginning of the year that's open enrollment, it's anybody that's on a Medicare Advantage plan. So if I'm on original Medicare, I cannot do anything in the first quarter of the year, but if I'm on a Medicare Advantage plan, then I can make the change. So let's say somebody decides they're on an HMSA plan and they decide to enroll in United for annual enrollment. And in the first quarter of the year, they think, okay, you know what? I think I made a mistake here. Then basically they can switch back to HMSA or to any other plan. So that's really what that open enrollment period is to help people that may have made a switch to a Medicare Advantage plan, give them an option at the beginning of the year to either go back to what they originally had or change it. Interesting. That's good to know. When you're doing outreach in the community, what are some of the most common questions you get and how do you address some of the concerns? Are there some common themes? Yes, I would say the biggest common theme would be dental care. Interesting though, but that's what we get asked a lot, like does the plan cover dental? And it's regrettable that original Medicare doesn't cover dental. But if I understand the story correctly, when they were designing Medicare, for some reason the dental association, they didn't want to participate. So it never became a benefit, but dental benefits are so important for our senior beneficiaries, you know, because it does really affect their health. So they're really looking at dental. Another one we always get asked about would be the vision for eyewear to get that because it's not covered under original Medicare. And then a lot of times after that, it's costs, unfortunately a lot of seniors do live on a fixed income and they're worried about what their expenses are. And then one thing with these Medicare Advantage plans that I would like to mention is that they all do have maximum auto pockets for their Medicare covered medical services. So it's kind of like a stop limit as far as what your auto pocket expenses would be in a calendar year. So if something really serious happens and your bills are hundreds of thousands of dollars, these plans do cap your costs. It'll start as low as $3,400 in a calendar year and may go up to as high as 6,700 depending on your plan. So there's also financial protections available in Medicare Advantage plans for the beneficiaries. But I would say dental and vision is the biggest questions we always get out there. And I'm sure with the provider access challenges in Hawaii, that's even more of a challenging. There might be coverage plans under Medicare Advantage, but the provider shortage is also coming up. Yeah, so that's really important. And when somebody comes to us and they say, oh, I don't have a primary care doctor, then it kind of gets a little challenging finding them one and then also getting an appointment. Cause a lot of times appointments seem to be maybe two, three, maybe as far as four months out for a new patient. So that's important. And I think with the advent with telehealth and Cloudwell, that's something that I think we would like to work more because when we do have people that need appointments right away, I can say it's very difficult. And then the other thing too is you are correct. It seems like a lot of primary care doctors are getting older, they're looking to retire. And then if somebody's not gonna take over their practice, then we'd have to kind of help all these people find a new primary care physician. So yeah, it's getting a little more difficult in Hawaii in regards to finding doctors, yes. At your point, this is where telehealth can be a valuable asset because the ability to see patients pretty much morning, daytime, evening, open 24, 7, 365, it really opens up the book to get patients, especially over the age of 65 who might have some chronic conditions, might have some challenges getting to a doctor. Easy access. Yeah, and I found a lot of the health insurance carriers are really going electronic. So the one thing good that I'm finding is, especially a lot of the younger beneficiaries, they're so used to email, they're so used to Zoom meetings at work because of all the shutdowns that they're a little more tech savvy and some of the older seniors are kind of getting that way too. So hopefully they're gonna be able to take advantage of those benefits to have their, see their doctors faster. More availability would be great for a lot of the seniors out there. Yeah, and telehealth under the Medicare Advantage Plans is a covered benefit, it sounds like. It is, yeah. And most plans with telehealth, it's gonna be an actual zero co-payment for the beneficiary, which is great. That's excellent. Any stories in particular of individuals that spend some time with you, spend some time with PBC and really had a good understanding of their benefits to make smart choices, good choices for them and their family? You know, when we work with beneficiaries, especially when they're new, I think the one thing that is, I would say difficult for them is that majority of people are working, they're getting their employer group coverage, they have a HR department. They usually have maybe one, two choices as far as their healthcare insurance coverage is. And when they're looking to retire, then it's like they don't have anybody to turn to. And so that's where we actually come in and we help them because there's a lot of moving parts when somebody's gonna retire. And the first thing is a lot of people may not have their Medicare turned on yet or they may have their Medicare Part A turned on. And then when they're ready to retire, they don't know the timeline. So generally when I meet with somebody, I let them know about two months before you retire, you wanna make sure we turn on your Part B. And we do help people turn on that, fill out the forms, they're gonna need two forms. Basically one is the application, one is goes to the HR department to confirm that they had medical coverage so there's no penalties. And then from there, we go through like a needs assessment to help them understand the different plans out there because they're gonna have a choice of anywhere from five to six plans to pick from. And usually with your employer group, you're only having one or two usually. And so it's definitely a different process for them. So what we do is we kinda just help them through the process, let them know what each step is and what to do. And I can say a lot of people at the end of the day are very happy that they had somebody to guide them through the process because it is definitely different when it comes to what you're doing with your employer group plan and what you do at Medicare. So I kinda like to say, just think of us as your HR department for Medicare and we'll definitely walk you through everything you need to do to make sure that you have the correct coverage. Yeah, I like that being the HR department because that's truly what it is. Yes. There's been a lot that's come out in the news and in the literature, especially because of the devastating impacts of COVID, many people have gone at least a couple of years without getting a checkup. And this is more significant of an issue with the senior population folks above the age of 65. So it's not only the point of getting everything activated to your, like what you mentioned, but also for purposes of getting yourself checked out. And making sure everything's okay. Yeah, you're right. And I think telehealth is gonna be a big part of it in a sense that we really had to pivot when there was the shutdowns because of COVID. We weren't sure how it's gonna affect us. Unfortunately, you know, I mean, fortunate for us in a sense, but unfortunately for people, they were deciding to retire early. They were losing their healthcare because they were losing their jobs. So we were really busy and then we had to pivot because nobody could meet in person. So, you know, we started learning how to do more of everything over the phone or electronically. And hopefully that, you know, with seniors understanding, you know, how to use the technology nowadays that they can definitely at least, you know, do their checkups with their doctors, get their wellness visits done so that they're on top of their healthcare because it's very important. Yeah, yeah. And telehealth is that unique ability to do annual wellness visits, annual wellness exams, where we go actively check in on you, see how you're doing, when was the last time you got your labs drawn, your cholesterol checked, et cetera. And that can be a great way to get the process started to make sure people are okay. Yes, yeah. And just the convenience of it all. I mean, I do know some people that do telehealth Medicare beneficiaries and they're very happy with the way everything is going. You know, they don't have to drive to traffic or they don't need to hop on a bus or whatever their means of transportation is or rely on a child that needs to take a day off to help them or something like that. So I think the convenience of it is remarkably remarkable for the seniors to make sure they're getting all their healthcare needs taken care of. There's probably some trepidation to use it at first, but once they do start to use it, they're like, oh, this is better than that. I'm gonna use it all the time. Yeah, exactly. Yeah, yeah. Well, Curtis, I know that you're a very busy person and I know this is a very busy time for you and the premier team. And I wanna take a moment to thank you for coming on the show. Oh, awesome, thank you. Yeah, this is a very important subject. A very important subject that can be very complicated to people who are new to it or for people to fully understand their options and you broke it down really well. And I appreciate that. And the community appreciates that. This is definitely something of significant value to everyone and thank you. You're welcome. And I would just like to say that if anybody or any beneficiary out there or that is on Medicare, if you do need help, we're here to help you and we never charge for our services. You can go to our website, which is www.PBCHawai.com or you can always give us a call in our office at 808-738-4500. And whether you're a client or not of ours, we will help you. There's a lot of people that give us a call that I know we can't service them because of their situation in regards to maybe being on a union plan or whatever it might be, but we'll definitely help you no matter what. So, and once we do help you with the plan, I just have to say that that's really, we understand that's where the servicing starts. I think you brought it up earlier in this conversation when we talked about appeals and things like that or calling customer service, but what we do offer is another layer of servicing to our members. So we always tell them, if you have to make a change as far as your address or need a new card, then please call customer service because we are not able to do that. But anything else, please make us the first call and we do service our members because we understand it's very important for them to get their right healthcare coverage. So thank you. That's great Curtis. That's extremely helpful and an example of you and your team providing care for the community of Hawaii and that really means a lot and we appreciate you being on the show. Oh, thank you so much. Mahalo. Thank you so much for watching Think Tech Hawaii. If you like what we do, please like us and click the subscribe button on YouTube and the follow button on Vimeo. You can also follow us on Facebook, Instagram, Twitter and LinkedIn and donate to us at thinktechhawaii.com. Mahalo.