 Thank you for coming. This would be an interesting thing. It's not working. This should be a little switch. He showed me where it was, but I forgot. Is there a teenager in the house? Yeah, where's Matt? How's this? Yeah, I can hear that too. Anyway, welcome. Today, of course, we're going to be talking about the various kinds of Medicare and Advantage. Christine comes to us from the CVCOA, Council on Aging. She has worked there for 24 years, so she knows her stuff. She's already answered a number of my questions, so I know she knows it. Enjoy, take notes, and have fun. Okay, thank you very much. Why don't we put that back up there? I'm not good with mechanical stuff, so I might break it. Do you want the lights? Let's see. Let's experiment. Can everyone see this? This is our slideshow. I'm Christine Melichorek. I come from the Central Vermont Council on Aging, and I've been there forever. My title is Information Assistance Specialist, but that's not what always my title was. They kept rearranging my job. This is my contact information right up there, so if you want to track me down afterwards, and at the end of the presentation, there will be a quiz to see how many of you know how to spell Melichorek. It's Slavak. It's actually Melichorek, but we don't have an English. So this is what we're going to do. We're going to basically do general introductions and talk about our services and understanding the different parts of Medicare, the supplement plans known as Medigaps, and talk about the drug plans and the financial programs out there. And fraud and resources that are available. So this is our generic slideshow that we do on Zoom once a month. So if you call our main office and you want to zoom into a class, you can sign up and they will send you this and some other type of handouts, and you'll automatically be plugged in for the Zoom class. The next one's October 10th, and it's an evening class. We do it every other month. We do an evening class one month and an afternoon class the next month, because a lot of people who come are just turning 65 and are still working. So that's why we do it every other month that way to accommodate people. So basically the first thing I want to know is how many folks are actually on Medicare? Okay, is there any newbies? One newbie, two newbies? Okay, okay. All right, so yeah, but you're heading that way. Oh, well the mail. We'll get to that. So basically it might be good for you after we talk here to take our Zoom workshop. No one understands this on the first outing, so people usually have to hear it over and over again. But since most of you are already on Medicare, what kind of questions do you have? Do you have more questions about the drug program or supplements or Advantage plans? Go ahead. Oh, I heard that there's going to be a big change at the end of the month, especially like Advantage. So did you have Medicare, Medicaid? No, I haven't heard that. Would you repeat the question? Was there going to be a change at the end of the month, Saturday? A lot of people are going to get kicked off. Oh, no. A lot of people are going to get kicked off. Yeah. What happened was with the programs, not Medicare and Medicaid, that's Medicare, not for everyone, but the Medicaid programs is that during the pandemic, they extended everyone's eligibility, so everyone did not get applications. And so now they're renewing them. And yes, as people, if you don't hand in your stuff to the Health Access Eligibility Unit, yeah, you'd get kicked off or if you found ineligible. So there are a lot of people who have left. Could you explain the difference between Medicare and Medicaid? Okay. Yeah, well, we're going to do that. Yes. So the gentleman in the back. The question I was having was that they're promoting these Advantage plants so heavily and I don't have that. I have the other supplemental. And I'm trying to understand the difference and why I, should I move to the Advantage? It doesn't seem like, anyway. Yeah. And the other thing is, I want to remind you, this is being taped. So probably if you have, I wouldn't blurt out your Social Security number, Medicare number, anything like that, because we are going to, there is going to be a tape of this. If you want a private consultation, you should call us, you know, call our helpline and they will schedule a meeting with you, either over the phone or in person with one of the people who are trained to do ship counseling. So, okay. So that gives me an idea of what you guys are looking for. So, whoop. Yes. So this is sponsored. Is that good? Everyone see? Okay. So the state health insurance assistance program called SHIP is, that's a federal grant and in Vermont it's given to the five councils on aging or area agencies on aging that are around the state. And we're trained to help people with Medicare and Medicaid issues. So we get the grant and then we go through training and then we do, this has become a lot more prevalent since they invented Medicare D. So we do a lot of ship counseling now at Council on Aging. Our consultations are free. All of our services are free, actually. Unbiased and it's confidential and we are not supported by any particular insurance company. We get money through the state and some Fed money and you'll see us in the town reports. We get town municipal money and we also take private donations and do fundraising. So Central Vermont Council on Aging is what's known as an area agency on aging. So back, who remembers President Johnson? Okay. Every five years old. Yeah. So he was, back in his administration he started a lot of programs. So he started Medicare and Medicaid and he did, created the Older Americans Act, was passed during his administration and that creates the area agencies on aging. So each state does it differently. In our state, the state is divided up into five sections. So we're in Central Vermont Council on Aging. Our main office is in Barrie. We are a nonprofit. So we're not obligated to sell anyone's product or anything like that. And our mission is to keep, give people good quality of life and help while they're still in the community. People are limited 60 or older. So we help people 60 or older and certain disabled folks who are a bit younger. Okay. So here are Council on Aging services. We do case management, information assistance. We help with food stamps, fuel assistance. We work with the Meals on Wheels programs and nutrition programs. We do the health insurance counseling. We have a caregiver program now because more and more people are staying at home and having family members take care of them. And those people need a lot of support to do that. Everyone's caregiving needs are different and no one comes with an instruction book. So we do a lot to support caregivers. We also work with Washington County mental health and we work with legal aid when people need that type of counseling. They don't necessarily provide lawyers but you could get some counseling. We have a contract with them for some counseling for legal issues. And we also provide transportation services. And we also like volunteers if you want to join us. So Medicare is a federal health insurance program. And it was invented about 1965 and it's for folks 65 and older. So the difference between Medicare and Medicaid is Medicare is for everyone once they turn 65. Medicaid is for people who have low income and resources. And we're going to talk about that a little more later. So certain people with disabilities can also get Medicare like if you have end-stage kidney disease, ALS, Lou Gehrig's disease. And if you're disabled for two years, you're on disability for two years, then you could get Medicare, you're eligible. So I think this is the most important slide we have in our presentation because it's a good roadmap. So when they first invented Medicare they invented A and B. Now A is your hospital insurance, you pay for that while you're working. That's where your taxes go. They go to the Part A trust fund. And once you work 10 years or your spouse 10 years or 40 quarter years, you are vested for Medicare A and you don't have to pay for it. If you don't work that about a time, then you have to pay something towards it. Medicare B is all your medical stuff. So that's doctor visit surgeries, durable medical equipment, OTPT, that type of stuff. That falls under Medicare B. And that you do have to pay for once you turn 65. Right now it's $164.90 a month. So if you're on social security, it comes automatically on your social security check. Then Medicare D is the drug plan they invented in 2006. Yeah, I believe it was 2006. And that is for, you know, they give you, you join a private drug plan. These two are administered by the government, by the Medicare centers for Medicare and Medicaid services. But the drug plans are private plans. So you purchase one of the plans. There are 24 in 2023 available. And this time of year, everyone gets ready to pick out their 2024 plans. Although they don't tell us what they're going to be until just before open enrollment starts on October 15. And then you could get a supplement to fill in the gaps in Medicare A and B. And those are private insurances as well. So I bet a lot of you have those. Yep, okay. So this is the original way to get Medicare. This is what is called original or traditional Medicare. Now back in the 90s, they started inventing managed care programs. And that's when they invented Medicare C. So if you're going to be on Medicare C, the advantage plan, you have to sign up for A and B. But then instead of getting D and a supplement, you can put that, your A and B on the shelf, and you can get by an advantage plan. And they have a drug component in Vermont too. So you don't have to get a separate drug plan. So basically, it's one way or the other. You can't have some of these and some of those, you either have to pick that or this route. So that's why I think it's the most important because it's a good overview of everything. So we start talking about advantage plans, the SPART-C plans when we do these presentations, because that's where people tend to have the most questions. So there are 21 of them available for 2023 in the state of Vermont. And they are managed care plans. So that means that you have to work with their network and in their geographical district. And then you have to get prior approvals for stuff or pre-authorizations. So that's more prevalent in the advantage plans. How many advantage plans do we have in here? About eight maybe. I don't know. You don't know? It's out long. Okay. A lot of people do. In terms of where you're being served, is it just New England or is there some kind of... This plan, does it limit if you're traveling or you have coverage? Yeah. So basically the advantage plans, they're all different. And all 21 of them. And most companies have several levels of them. So AARP or Blue Cross Blue Shield, Well Care, any of those guys, they have the cheapy plan where you only pay the $164.90. And that's all you pay. So you don't have to pay for a drug plan or supplement any of that. And they have a medium plan, which is $50 to $75 extra you'd pay. And then they have a Cadillac plan over 100. And they all give different service levels. But with advantage plans, it's like I said, it's an alternative to original Medicare. It's private insurance. So all of your services go through the insurance company you pick. You continue to pay for your Part B premium. They continue to take it out of your Social Security to check. And the services are provided through preferred provider networks or HMOs or certain networks. And the best bet is to work within their networks. The networks that have the doctors who signed up with that particular plan. And some of those prices are very low when you use those doctors. Is it possible to get information and to sign up if you're not doing it on a computer? I never have done it. Yes, you can call if you want. You can call at our helpline and we could sign somebody to you. But they're going to talk to you about the different types of plans. The thing with advantage plans is unlike Medicare supplements, they're not comprehensive. A lot of the Medicare supplements, which we're going to talk about in a little while, the old-fashioned Metagaps, they cover everything. The advantage plans, you usually have a copay every step of the way. So you're paying 10, 20, 30 bucks. Yes? Excuse me, if I had the Blue Cross Blue Shield advantage plan, is that what we're talking about here? Yes. But the premiums are higher that I pay. So you might have not gotten the cheapy plan. You may have gotten either a medium plan or a high dollar plan. But even the high dollar is more than 100 dollars. Some of them are. The prices are all over the place. But most companies do offer a plan where you just pay your 164 dollars and 90 cents. But when you go to the doctor, you have to pay a copay when you walk in the door. You have to work within their networks. Some of them are, some of the plans have very broad networks, probably the bigger name ones. And some of them have pretty narrow networks. So one of the complaints about advantage plans is I can't find a provider in their network. And while now we're having a shortage of providers, so I can't find a provider in their network who will take me. So that's another level of confusion nowadays. And you don't have the government behind you if you have a problem with these private insurance. Because Medicare advantage is totally private. You don't have the government backing you if you have a problem with them. You have to deal with a private insurance company. That's right. Well, that's your first step. But a lot of times people do turn to Medicare and they advocate for people. Or we do that too. If you get sick, you go back to Medicare. Well, you can do that, but there's a bit of a trap there too as well. So these cover the same things as original Medicare, but at different prices. So it's not like regular Medicare covers things at a set price. If they're a Medicare doctor, it's the same all over the country. Do you have another question? So these Medicare advantage plans are all run by profit-making insurance companies. Correct. Right. Right. And basically, so your $164 comes out of your Social Security check. It goes to the Medicare Part B Trust Fund and then it goes to these private insurance companies. And then they also pay them a little more for administrative purposes. Yes? You're a member of a teachers' union and they arrange something. Mm-hmm. Is that a disadvantage to a leader? It seems to be a leader. It depends on what they're offering. So usually we do private consultations with people. So people who are from teachers' unions or maybe the old IBM plans, things like that, what happens is they get their summary of what the plan is going to offer in the next year. So they bring that to their consultation and we go over what the different options are. If you go on regular Medicare, original Medicare, you go on AB. We talk about supplement options and drug options. If you're going to go on an advantage plan, a private plan, we show you the plan details for that particular plan that you're interested in. And if you have something else, you should have a summary of what that provides. And they have switched some, in my case, to ground from Medicare advantage. Mm-hmm. They decide each year. Right. Right. And that really annoys people. What's Kara say? That with the teachers' retirement plans, they often switch yearly what they're going to provide. So they provide you, if you're a member of the union, they provide you with insurance, but the form of the insurance often changes every year. So that gets very... That's true, yeah. So you'd want to, on the back of your insurance cards, you usually have a customer service number and you can call up and ask what providers you have in your area to see if your doctor is covered. And yes, and with this, if you're going to take an advantage plan, if you really love your doctor, it's really important to find out that they take that plan. Some plan doctors don't take AARP or MVP or Cigna. So if you really like your doctor and you want to keep him or her, before you sign up, you want to check with their office that they actually take that particular advantage plan. From what you said, apparently, as opposed to the Medicare advantage plans, original Medicare does not have to be only for people who are in for doctors or in the... Their network, yeah. Well, what doctors do all around the United States is they sign up with Medicare for the original Medicare. Any Medicare doctor and most of them do sign up. There are some who don't, but most doctors sign up for Medicare that they're going to comply with the Medicare rules and you could go anywhere in the United States. And a lot of these supplements are the same. So let's say you have a Blue Cross Blue Shield or one of the bigger names. If you're visiting your grandkids in South Carolina and heaven forbid you break your ankle, you can go and if you're on regular Medicare and you could go to the hospital and if it's a Medicare hospital, yes, they will take care of you. The most hospital sign up for Medicare? I'm sorry. The most hospital sign up for Medicare? Oh, yes. But if you're out of state, they can also balance bill. In Vermont, there's a rule that if you accept Medicare as a doctor, you cannot balance bill. But if you're over at Dartmouth, say they can balance bill you. Yeah, there's excess charges in other states. We don't have that here in Vermont. So if Medicare pays, let's say $100 for a doctor visit, that's all the Medicare doctor can charge in the state of Vermont. Other states, if they charge $125, they, you know, Medicare will pay the $100 and you have the $25 bill. So when you're traveling, it's a good idea to kind of figure out what you can do ahead of time if you travel a lot. So a lot of times to see a specialist, you need a referral with the Advantage Plans and prior approval. And you have to, like I said, you have to check with your providers to make sure that they are in fact, you know, that they in fact take the plan that you choose. Remember, there are 21 of them and they're all different. So, and hopefully at the end, we'll have time to show you how to look at the differences. So we start there also because people get tons of mail this time of year from Advantage Plans. So, and other people, and we usually talk about this at the end. You have to be very careful with your mail. There's a lot of scams out there, those postcard things that don't name a particular company. Just throw them away. There are some. Most Advantage Plans salesmen are pretty honorable, but there are some who really push the limits. They show up on your door stoop or give you a call even though they're not supposed to call you unless you're already signed up with that plan for something. So you have to be very careful because this time of year, there's a lot of stuff out there. The other thing is the TV commercials are notoriously inaccurate. So if before you choose an Advantage Plan, it's really important to look at the plan details. Is it October 15th that you've signed up? October 15th through December 7th. Every year, you can switch your Advantage Plans and your drug plans. So people who prefer original Medicare, we already talked about this. They want flexibility. They want to manage their own health care. They want to travel. Or they live somewhere where there's no Medicare coverage. So Medicare A, as most of you know, is hospital insurance. You paid for that after 10 years of work, during 10 years of work. You have to be admitted though as an inpatient, not observation. Medicare A will only pay if you're an inpatient. What does it mean? That when you're admitted, that's what you're classified. What does that mean? Well, that's how they admit you at the hospital. They put you under the category. So the admitting doctor would put you either in for observation or as an inpatient. Now the inpatient... It was three days before you get the other benefits, yeah. So basically, if you otherwise Medicare B would pay, which would be 20%, which you would get to. So basically, if you are in for three days, there are some other benefits. You get skilled nursing care for rehab, not permanent placement in nursing home just till you feel better. You break your hip. You're in the hospital for three days. Then they ship you off to a nursing home to get better. This is not talking about long-term care like you're in there permanently. This is just for temporary. Also, you get home health care if you have... It's paid for under Medicare A if you're in for three days. And hospice, which is... If you have a terminal condition and you're near the end of life, you can join a hospice program and Medicare A will pay. There's no premium, like we said, for Medicare A. There is a whopping big hospital deductible, though, $1,600 per benefit period. The benefit period starts when you enter the hospital and it ends 60 days after you're discharged. So if you don't have a supplement or something else or Medicaid or something else paying that, you could pay more than one a year. More than one deductible a year. Does everyone understand that? Okay, that's an important thing to know. Yep. But if your bill is like $50,000 or something paying $1,600 sounds kind of reasonable, and they pay the balance? Yes. Okay. Yeah. During the benefit period, yes. Right. Yeah. Yes, it is, but when you're on a fixed income, $1,600 is a lot of money. Yeah, absolutely. Yeah. So the benefit period means per incident, per admission? Yes. Is that what that means? Yes. So if you have multiple emissions over a period of time for different things, you may end up paying more than one deductible. This is why it's important if you can afford it to get a supplement to cover that particular bill. Yep. There was something when you had to be hospitalized for three days before you went into rehab or nursing? Well, rehab is done in nursing homes. So nursing homes usually have two types of services. Many have many more, but they usually have rehab, rehabilitation. So that's like if you have an acute condition. So for example, you fall down, you break your hip. You have the surgery. You're in the hospital three days. They ship you off to, I don't know, the manor in Morrisville. And then while you have a certain amount of time, they will pay for you to be in there. Then if you have to be in a nursing home for a chronic long-term condition, that's not covered by Medicare. At all. No. So. And if you go in with, and you do need chronic care, along with your bad leg, they won't cover you if you're not improving. Right. Well, that's when you apply for another program. All the time for getting worse. They'll cover you. Yeah. So, yes. And you've got to get improved enough to go home. That's what they're doing. They give you PTEOT, and hopefully you improve enough to go home. You're not going to be playing basketball. But neither am I. So Medicare B is all of your medical services. And we talked about this already briefly. There's outpatient stuff, lab tests, X-rays, PTEOT, a durable medical equipment. All of that good stuff. Dialysis, if you're unfortunate enough to have end-stage kidney disease. So Medicare B pays for that. And this is what you're paying the $164.90 for. And to find out what's covered by Medicare B, there are a few different places you can look. One is the Medicare in New Handbook, which you should get one at the very soon. There it is. A 2024 is out. If you go online, they'll send it to you online. I just decided I'd give. I want to go online because I told everyone I could hold them. I am. So if we have time, we're going to go to Medicare.gov. So that's where you would find all that information, too. Or you could call Centers for Medicare and Medicaid Services. You could go there, too. So a lot of this stuff is online. Some people prefer the book. That way they could draw, I don't know, funny cartoons of their doctor. If you go online, they're going to send it to you online. That's the problem. So this is how you figure out what is covered. Now to be covered by Medicare, one of the rules is it has to be medically necessary. So sorry, guys, your facelifts aren't covered. So... The mirror says so. Pardon? The mirror says so. The mirror says so? Okay. So you'd want to look it up. Okay, so we talked about the $164. Now if you're on Medicare, there is a B. There is an annual deductible of $226. You pay the first $226 starting every January. You have to pay that deductible. And then Medicare covers 80%. You pay 20%. So that can really add up. If you figure that a knee replacement costs $50,000, 20% of that is $10,000. So that's why people buy the supplemental insurances to cover that. Now it says there's a footnote here for most people. People who make over like $90,000 a year or double that for married couples, they can be charged an extra premium. So most people get the $164.90, but people who are making good money, they may get an extra premium on top of the $164.90. But it's like $90,000 before you hit that. So okay, late enrollment. If you don't sign up for Medicare B when you're first eligible and you don't have credible employer insurance, you can get a penalty when you do. And the penalty is equal to 10% a year. So if you wait three years, you just get Medicare A. You wait three years to go on Medicare B. You're going to have a 30% penalty. So that can really add up. 40% of what? The premium. Annually? You're saying? No, every month. Wow. So it would be $164 plus this year, plus the 30%. So if you figure even if it's just $10, that really adds up. Yeah. So yeah. Everyone grumbles when they hear that. It's always grumbling in the room. So it's best to sign up when you're first eligible. Now some people continue to work after they turn 65. I'm one of them. I turn 65 in April. And I decide to stay with the council on aging plan that I've had for a long time. So I'm not for until I retire in one year, three months and three days. But who's counting? I will be on council on aging insurance. So you have a choice. But that depends on a few things. First of all, if you're employer, and this is for yourself or your spouse, you have to be legally married. If they have less than 20 employees or 100 if you're disabled, you need to go on Medicare. You need to sign up. What did it just do? There we go. You want to check with your employer about drug coverage and if you could use your employer insurance as a supplemental. So for folks who work for places that have over 20 employees or over 100 if you're disabled, you can put off signing up for Medicare and you won't be penalized down the road like in one year, three months and three days. So you can delay the penalty. It has to be you or your spouse. And if Medicare is less expensive, you may want to go with that. If it's more expensive, you may want to stick with your employer insurance. And then you would check with your employer, you know, if you could sign up for A or if you have an HRA or HSA, you know, health reimbursement account or health savings account where your employer gives you a debit card money on it for health things, you want to check with your employer then because some of those end, not all of them, it depends on the contract between the employer and the company that holds the account. Some of them end once you go on any Medicare. So you definitely want to make sure that you're not going to lose that extra money if you go on Medicare Part A. If you don't have one of those, Medicare Part A is free, so you might as well do it. Okay, signing up. We recommend three months ahead of time before your 65th birthday or three months before you plan to retire. They, of course, vet you. You sign up with Social Security. We live in the days of identity theft. So they do, you know, they vet you. They check out that you are who you really say you are and so your benefits aren't used by someone else. I went to visit a woman once and she had her benefit statement and it said she had psychiatric help in Florida. She never been to Florida. So someone had obviously taken her number and was using it down in Florida to get some sort of psychiatric help. Probably drug-related, but we never found that out. So basically when you turn 65, you have a window. You can sign up three months ahead of time. The month you turn 65 and three months later. So you have a seven-month window when you can sign up. So if you're still working, you probably want to sign up a month or two ahead of time and start Medicare on the day you're not going to have insurance anymore. So, and that depends, that's different for the different employers. So, some people are automatically enrolled if they're already on Social Security, either through disability or early retirement. They're automatically enrolled in Medicare. They don't have to do anything. As far as A and B goes, you have to do things about the other stuff. So that's basic Medicare A and B. Now we're going to move on to supplements. The supplemental insurance companies, the Metagaps, which probably you guys are curious about. Are we doing okay so far? Yes. I don't see anyone, hear anyone snoring, so I guess we are. So supplemental insurance is these piggyback on Medicare A and B. And they are private policies. They're designed to cover the gaps in A, which is the $1,600, and B, which is the 20%. To get one, you have to be signed up for Medicare A and B. You cannot have an Advantage Plan and a supplement at the same time. And you cannot be refused for a supplement the first six months after you go on Medicare B. It's called guaranteed issue. So in one year, three months, and three days, at that point I can sign up, even though I'll be over 65, I can sign up for a supplement, and they cannot turn me down. Because that's when I'm going to start Medicare B, or that's the plan anyway. So that's very important, and we'll tell you why. You usually enroll directly with the insurance providers. So there is, if you look on your Medicare workbook, you can see there's information on Medicare supplements. You can also go to the Department of Financial Regulation and see what's available in the state of Vermont, which I'm going to show you in a minute. Or you could call an insurance company, so you could do it either way. So the Medicare gaps are governed by federal rules. And here they are. So this is the stuff Medicare doesn't cover on this side of the page. This is in the Medicare handbook. I'm not sure where it is in 2024, but I think it was page 70 or something like that. So these are uncovered. And then to make your life more confusing, there's Medicare ABC and A. The Medigaps are also named ABC and A. So a Medigap C plan is not the same as a Medicare Advantage C plan. So all of these levels cover something else. So you'll notice A does not cover the Part A deductible, and so if you get an A plan, you have to pay that $1,600. Most of them cover the 20% from Medicare B. Some cover a foreign travel if you want to go to Europe a lot. That might interest you. Some cover, let's see, those excess charges, you might get out of state. They cover that. So the one thing they don't cover is the Part B deductible. Now the plan C up there and the plan F say they do, but there's a catch with them. Those are no longer available. So that turned 65 before January 1st, 2020 to get a C or an F plan. So if you did turn 65 before that date, you can go to your insurance company and get those plans. The rest of us have to pay the deductible. There are also other plans, and we're talking about a J plan before. It's so old it's not even on the list. But they're grand plans. I pay $255 a month for my health pay. Yeah, for your premium, what you pay a month. Which I think is ridiculous. Well, we're going to talk about prices in the next slide. So the other thing is, so the G is the Cadillac right now. That's the best plan you can get right now if you're going on Medicare. And then the K, L, M, and N are hybrid plans. So they cover like 20 or 75% of the 20% as opposed to the whole thing. They have out-of-pocket limits though, which is attractive to some people. And the N plan, it covers 100%, but when you read the footnote at the bottom of the page, you'll find out you have co-pays when every time you go to a doctor. Okay, so these are the federal regulations. Does everyone feel okay with that? Everyone nod, okay. Oh, yes, sir. How do you choose a supplemental insurance company? Yeah. Well, we're going to show you what's available in Vermont. So if you're going to sell these anywhere in the United States and A or C or an N, you have to follow these rules. These are the general rules. Then you go to the state where you're going to buy it. So this is our state. So this is from the Department of Financial Regulation website. And basically, the companies, they say, I want to sell this type of plan or that type of plan. Then they have to go to Vermont, go to our Department of Financial Regulation, and get essentially a license to sell. So these guys all went and got permission from the state of Vermont to sell the particular plans that are listed here. 2022. So the prices are about there. Yeah. So you're looking at approximately those prices. Well, if you think about what you'd pay in the private market for insurance, $1,200 per person, they do go up a little bit every year. Now you'll see the C plan and the F plan are grayed out because they're no longer available. There are, there's a whole variety of prices. Some like State Farm and United Healthcare, which is a United American, are up to $2.66, $2.67. The cheaper ones, Ascendo is no longer providing them. But you have Medigap Blue. And you also have, let's see, Continental Aetna. They're pretty cheap. They're $165.02 a month. If you look, I'm looking at the F plans, but if you look at the G plans, you're looking at $168 for the G plan for Continental and $167 for the Medigap Blue. So there's another Blue Cross Blue Shield up there that you'll notice. So what Blue Cross Blue Shield does is they have two levels of plans. The cheaper one is the one you go on when you first turn 65. So in that six month window after your 65th birthday, if you sign up, you can get that plan. If you wait, like say a year or two, then you go on the more expensive plan. So that's how Blue Cross Blue Shield does it. Now I said there were guaranteed issue for six months. And that means after that, they don't have to give you a plan. So if you're on a more expensive plan, let's say you're on the State Farm plan for, let's go to the G, or Humanity. The Humanity plan is 207. You want to look for, oh, Global Life is 241. So you want to look for a cheaper plan. So let's say you call up another insurance company looking for a cheaper plan. They do do underwriting and they look at prior conditions. So they don't, and they don't have to accept you or they can charge you more. It's in the plan's discretion. So it's very important that when you go through that six month period, you pick a plan that you would really feel comfortable with long term. Are you saying pre-existing conditions would be considered? Yes, after six months. And the idea is that they want you to get insurance while you're still young and healthy. And that means 65. I'm glad to hear that. But if you wait till 80, when you have a heart condition, you might not necessarily get insurance. So every insurance company that thought for us to sell Medicaid insurance has to give you the six months without looking at anything. That's right. They don't look at your prior pre-exist. That's kind of the deal to get a license. They don't look at the pre-existing conditions. For six months. After that, they can. So Blue Cross Blue Shield has their method of doing it the higher priced, one the one that costs $100 more a month. But other companies, they can charge you, I don't know, a few extra dollars a month or they can deny you. So if you wait till you get cancer and you go apply for a plan, you may not get the insurance, the supplementary. To be denied, you met a gap coverage because of pre-existing conditions. Correct. After six months. After six months, right. And then if you're going shopping for cheaper plans, sometimes they look at that stuff too. But sometimes if you've already had a plan, they, you know, they, you know, they say, oh, well, you've already had a plan. So, you know, join ours. It's their discretion. It's there what they choose to do. So, and this is right on the website for Department of Financial Regulations. So you could look that up. Where do you buy one? Here are the phone numbers. Of all the companies that sell them, Ascendos no longer in the state. So, you know, you have Blue Cross Blue Shield. You can apply online, buy an application they can mail you on. You could call them up. Sometimes they do it over the phone. You know, they all have their own method of signing you up. But you can, you can do that. What's the most proud of it? Well, they're one of the cheapest, yeah. But there were people who swear by AARP, you know. My mother had it. My uncle, United Health Care, yeah. So there are people who... Two hundred and fifty-one dollars. But I don't, if I go in the hospital, I don't have to pay any deductible, or if I don't pay any deductible, even in January. Yeah, so that would be... Yeah, so that would be like the old C plans and the old F plans. They pay. Yeah, and the J. J's not on the chart. They would pay your 226 dollars. So, but now you can't buy that. If, unless you were turned 65 before January 1st, 2020, then you can. So if you, let's say, you worked for five years and you're, you're 70 years old and you're just buying, you'd be eligible to get the C. I think I'll move to Scandinavia. They have a little... Yes. So... What percentage of people have metagasic insurance? Do you have any statistics on that? No. No, because usually it's people who have incomes of, that are above, above the state programs that help with health insurance. So, we don't know exactly. Okay. So that's supplemental insurance. Then we have Medicare D. So if you get a supplement, remember you're probably, if you get a good one, you're covered. So first, the doctor bills Medicare, then they, or the hospital, and then they bill your supplement and you usually have nothing to pay at the doctor's office. Medicare D is the drug coverage they invented in 2006. It's prescription drugs only and all of these are also private insurance companies. There are 24 of them in the state of Vermont this year. You choose the plan based on your medications. The premiums, the deductibles, and co-pays vary with each plan. So you want to look at the plan details. You go to Medicare.gov and hopefully we'll have time to go there in a few minutes. And we have a video on our website, the CVCOA website that tells you how to enroll. So if you get everything I say, you could always go watch the video. Annually between October 15th and December 7th, you get to change your plan. So that's open enrollment and that's coming up. And that's when you get all that junk mail. But that's open enrollment for everything you have to do with Medicare. No, it's only for the drug plans and the advantage plans. The Medigaps you could change every year if the drug company will have you. But if you're choosing advantage and then you want to go back to Medicare, you would do that. Right. Yes. For the beginning, it starts January 1st, then your new coverage. So here again with the Medicare deep plans, if you don't sign up for them when you're first eligible in that seven month window, there's a penalty. So there's an annual notice of change that shows up every September telling you if your plan is the plan you're on is changing. If you do nothing, you just roll over. And that's the same with the Medigaps and the advantage plans. There is federal assistance and state assistance out there. There's Medicaid, Medicare savings plan, low income subsidy and VFARM. And as you could see, the income levels are awful low. So to be on Medicaid, you'd have to make as an individual less than $1,258 a month. But as a couple, it's the same. So even though there are two of you, you do have to, you are able to keep $1,000 more in the bank. But basically the income level is pretty low there. Yeah. Yes, sir. I got my notice for a change recently and it seems to repeat a pattern that has happened for the last several years where I get a high deductible part D because I'm lucky right now I'm not using any drugs but to maintain the and so when I'm finding that like this year the repeat of the plan signed up with is increasing by 130%. And that's not the first time that's happened. It seems like I have. So it's just interesting that you have to do have to look pretty carefully at that and go, I find myself bouncing back and forth from if I'm just basically maintaining it just to say that I have the cover. So what we usually do with people who have no drugs and they don't want to pay the penalty down the road is we put them on the cheapest plan out there. So the cheapest plan out there for 2023 was called SilverScript Smart. It's $6.80 so so basically people who don't have drugs go on the cheapest plan so they don't get penalized down the road but because your penalty will probably be more than $6.80 and every year they could go from that cheapest plan to the next cheapest plan. But yeah, you need to come and visit us. It's interesting that once they've been like paying $6.00 a month and then all of a sudden the next time it was going to be $15.00 a month. Right. And then there is there are companies who start off really low $12.00 a month or whatever and then before you know it you're paying over $50.00. They jump up every year because you roll over if you do nothing. So they count on people. Yes. A comment question. I do have I check my drug plan every year and I guess I have from the beginning which you said is so sex maybe. Right now SilverScript Smart is $6.80. My point is this. It's worth checking. I have changed drugs almost every year. There have been exceptions but almost every year I've taken because I go for the Jesus and that works fine. And there is, did you mention the tool that's available on the meditator? Well, I thought we should go to that. Because that's what I use and it's very simple. You can put either drugs or no drugs. You can have it in there or in person and it lists them in whatever exactly. I'm going to skip since we're on Medicare D and this is where you get the app. We already talked about a lot of this stuff so I'm just going to close this program. Is this on your website? This one no. This one no. What's on the website is Did I do something? Let me do this. And then I'm going to go to Google where I have the medicare.gov So this is the first thing you need to know about medicare.gov. This is where you pick out your D plans and your Advantage plans. So the first thing you need to know about this website is they have smiling people. And every few months they change the smiling people. So if you go on this in three months this may not be the same smiling people. Don't get confused. Get an account for yourself if you would like. With a password and username and all that stuff that a lot of people do that and then they never remember what they are. But if you do it pulls up all of your activity from the last year. So some people find that who are more tech savvy than me find that very helpful. We usually go to find plans. It says there's a place to find care providers and talk to somebody. So this is this is going to have to wake up down here. Blink again. Find plans. Okay so we have another smiling guy and so you know you're in the right place you can log in or you can put in your zip code. So my zip code is 05661 for my office so and then it asks me what I want to do. So let's say I'm looking for a drug plan I hit that button and then I hit find plans. Then it asks me if I'm on any of these programs because the prices are different if you're on the programs but I'm going to put I don't get any help. Because that's simpler to show you. And this is what the video on our website says then you go to next. Okay do I want to see the price of my drugs? Yeah. So then it tells me I'm doing great. And then things very blinking. Pardon? Talking too fast. So then you put in your drugs. So let's put in a few drugs. Metformin for those of you who don't know is for folks who are diabetic and as you see there's different types of metformin so you want to make sure to put in the right one. So for today we'll go to this one. A Laga Pinatin metformin. So then I hit add drug. And then it gives me a choice of what my dose is. So let's say this doesn't give much of a choice so it's 12.5- 1000 or 500 milligrams. I put in my dose and then how many I need a month. So let's say I take two a day. I could also do this by three months or a year. So if you're with a company where you get cheaper if you buy three months you could figure that out too. But we're going to stick with the basic way because I get confused. So we're going to add that to our list. So that's on our list. So let's go to Synthroid. And there's a reason we pick that one. Synthroid. So oops. And then add drug. Okay so now it's telling me that there's a I'm going too fast. I'm sorry. My drug has a generic so I don't have to buy the Synthroid. I could get level 5 rock scene as the generic. So that helps identify generic drugs. Okay so let's add that generic instead. And then this is the standard dose for most people. Sorry I'm touching every time I touch the mouse it does that. So let's just go with the standard dose. I take a 50 MCG one a day every month. So 30 a month. Then we could throw in a torvastatin. Okay that's a good one. Yeah I use Simvastatin but a torvastatin works. So let's see what happens if we add in a torvast there. So it pops up even if I don't know how to spell it. So is it with amlodipine or not? No amlodipine. Okay. So there is a torvastatin. And what size? That looks good. Okay 40 milligrams one a day so for 30 a month. So let's say then so I add that to my list those are my three and then I go down here and I tell it I'm done adding drugs. And then it asks for me to name my local pharmacies. So I usually spread the net pretty wide 25 miles and these are pharmacies that are available within 25 miles of the zip code I put in there. So there's Hanifords, there's CVS let's see there was a mail order I forgot the mail order if you want to look at that so you could put in up to five at a time Hanifords supermarket CVS there's a Kinney's yep here's our Kinney's the Kinney's oh good okay cause I just called them today okay and we're having a new one open up on on mountain road in the state we're going to hit that just for kicks and giggles so we got five pharmacies there the reason is some of the pharmacies are not in the network in other words they don't have a contract with that insurance company some are standard pharmacies so you get a little bit of a discount and some are preferred the preferred is where you get the best price so then you hit done and it tells us what it gives us a list of what pharmacies would be best and it sorts it by cheapest premium and cheapest cost now this is for the rest of this year so they say if I'm going to go on this plan well care value script would be the cheapest for me that's a good one that would be a sense a month so that's cheap my total cost for the rest of the year would be $714 and then let's look at number two SilverScrivSmart that's the cheapest one in 2024 there we go we'll look at one more Sigma Saver so that would be the third cheapest now what you can do you done okay what you want to really do is you want to go to plan details down here right so that if people aren't tech savvy they can meet with the person you can do it on the phone we'll do it on the phone or in person during the pandemic we did right so but the thing to remember is we're coming into open enrollment right now so make your appointment now make your appointment now because after Thanksgiving we're crazy we don't even answer the phone so if you want an appointment the best thing to do is make it as close to you know make it ahead of time so I'm making appointments already for the 25th of October so yeah well the 10 days that I can make appointments the main office makes other appointments for me so it's pretty easy to do on time it took me a long time you can do it you can do it and we try to encourage people to learn how to do this so the plan details here there is a drug deductible but it doesn't necessarily mean you don't get the discount do you have a question? a comment yeah I think it's important to know whether they are companies that are in the United States or some other country yeah because the service you get will be totally get that so yeah you would want to know that would be one of the factors usually the I think right up at the there is their address is in here maybe it's at the bottom oh there it is so this one's in Florida this is Cygna so now if you go down here there are preferred pharmacies and then they are in network the preferred are going to give me the better bet going to give me the better price and if you want to know what the prices will be remember this is just for the end of this year there's a list of prices that's right you want a preferred pharmacy they're the cheapest ones so as you could see in at Hanifords your a tour of a statin that gentleman would only pay would pay zero that would be his co-pay and if he went to CVS it would be $35 so that's the difference between a standard pharmacy and a preferred pharmacy preferred for that particular plant that particular plant and for that year because I just noticed from Welpair that they changed their preferred pharmacy for next year remember you get a notice telling you what changes there will be is that a preferred pharmacy for only that drug only this plant only that plant right would be preferred you'd get the cheapest price so if you're with this let's say you're given another drug you can you'd get a preferred price but you wouldn't have it itemized like this so I would stick with Kinney drugs or Hanifords or mail order if I wanted the best price so another problem with mail order it's one of those things that the drugs are shipped third class third class they go second class third class if it's in the bucket at the end of the day it stays there for the next day probably for the next day or the next day and has big problems with that and that is a consumer preference yeah, some people and some people who get their mail in an old fashioned mailbox don't really want them left out at the street especially if you're getting opioids or something you know yeah, and the one in the Morrisville does as well so these are my estimated costs for the rest of the year including my premium and then calendar year October, November, and December well, January you can switch for January so between October and December you pick your plan for the next year what's the deadline in December? the 7th which is Pearl Harbor Day Pearl Harbor Day, very good you passed it you can't change it in January if you've already selected something that's correct unless you're on one of the state plans then they have different rules but if you're just a regular person not on any state plans you pick then unless there is some misrepresentation or something like that oh, what you pick in October is what you get until next October no, you get to January 1st to January 1st so if you pick it in October it doesn't start until January so you have to live with it so if I turn 65 then we're in the next year when should I look at starting this? well well, three months yeah but you would do sign up for A and B first you have to sign up for A and B first because then you can't get a drug plan unless you're already signed up for A and B so that means Social Security made sure you are who you really say you are so there's some additional information here you could click on this button and it gives what the retail cost would be at Kinney's and then what the discount cost is so you could do this with all 24 plans if you have the patients and if you want to try this yourself you could go on you don't have to create an account or anything go on there and play it to your heart's delight but during open enrollment sometimes it crashes they could change the cost mid-year too well, they're not supposed to so that's another issue yes, sir? if you can go to Canada yeah, people do that and there are some there are some drugs I'm thinking of one particular cancer drug that's thousands of dollars a month yeah, yeah and if people do that they also ask for financial aid through their CV is it still CVH and UVM they all have financial aid programs for drugs and if you're ever really stuck most primary care doctors have social workers with them now and they can look up they can sometimes get you a deal okay, so now have we had enough fun with this? I want to show you one more thing so I'm going to go back all the way back up and it's going to blink like crazy so I'm going to go back to the search results for drugs so these are the this puts my 24 plans in order but if you want to okay see up in the right hand corner there it says view 21 available Medicare Advantage plans if you want to check out the Advantage plans you push that button and we're going to have a lot more flashing here for those of us who get migraines this is not a good thing so if you hit that it automatically shows you all of the Advantage plans and it's the same type of thing we have a well care no premium well care give back well care no premium there's AARP another AARP UVM MVP plan a lot of people like that one so if you go to plan details again this tells you what all of your services will cost so let's see UVM Advantage here that's in collaboration with MVP so health care deductible is zero drug deductible is 250 but that doesn't mean you're not going to get a discount you pay your regular premium and then here are your benefits so primary doctor zero out of network doctor five dollars specialist 35 out of network 50 and you could go all the way down here and look up whatever you want so for hospital instead of paying the 1600 you'd pay 450 for the first two days so that would be 900 then you go down here and the one preventive services are always free and then if you occupational therapy physical therapy all that so let's go down so here you have all of these are in network but so they're not preferred but yes the prices for at kines would still be zero for two of the drugs so so that would still be you know the same price but if you go then let's go down farther your drug costs for the rest of the year you could hit this for more and all right extra benefits this is what a lot of people want to hear about and this is why a lot of people get advantage plan yes there are there is hearing coverage if you go in network you pay zero for your exam you pay zero out of network you pay 50 fitting evaluation you can see this for yourself the aids cost anywhere from 699 to a thousand and then there's dental and the thing with dental is there's two types of dental so there's preventive dental this is what you have twice a year you're supposed to have you know you're cleaning your examination your x-rays there's zero co-pays for that but fluoride treatment is not covered if you just have Medicare it's not covered that's correct regular Medicare does not cover dental hearing or vision pardon this is an advantage it is a yeah so it is this is the uvm advantage plan so their network this network covers all of New York except for the city in Long Island and all of Vermont so they have people everywhere so then there's comprehensive dental so this is where things get scary this is your fillings your drillings all that horrible stuff they do to you that you don't want to think about as you could see they would cover up to 50% of that so if you have you know a crown which costs $3,000 they might cover 1,500 of it and I'm guessing if you're poor and you just don't want to pay all the money that the dentist charge you can go down to the Vermont technical column in Williston and it's quite a bit less I had my x-rays done down there and those were regular dentists and we have a clinic up in Morrisville but right now they're not making appointments because they have such a long waiting list so and then vision is another thing people look for glasses again you know you're going to look for in-network but your eye exam would cost you 50 out-of-network, zero in-network and then but you'll also notice in the right hand column it says limit supply so let's hit one of those in that right hand column it says limit supply so we're going to hit that now the top one there may be limits on how much the plan will provide so that's like getting prior approval you want to get prior approval for a routine eye exam so your doctor your PCP could say yes it's time for your eye exam and the line tells me that all the time and I ignore her but no I don't ignore her I listen to her actually okay so those are how you find out your advantage plans Medicare D plans and the other way to do it is you call the Senior Health Line at Council on Aging and make an appointment so questions, comments yes ma'am well you have to use their network for most of them and they all have different contracts with different providers so if Dr. Smith down the road doesn't want to work with Blue Cross Blue Shield he doesn't have to sign up with them if he wants to work with AARP he can sign up with them so also some of them are geographically limited like this UVM plan it's for mostly upper New York State and Vermont so South Carolina is you know you wouldn't have coverage there so those are the things people look at also some nursing homes if you're going for rehab they only take certain plans so yes can you talk a little about OneCare and what it is Well OneCare is going to be a network they're trying to develop under the Affordable Care Act and basically you sign up with the network and everyone gets to share your information I don't think it's really being as effective as they want it to be so a lot of people are opting out you get a choice to opt in or out at your doctor's office you look confused Lady and Green OneCare OneCare is a network so basically if you go to one doctor who's a member of OneCare all the doctors in OneCare can get your information there's hardly any doctors that are under that it's an ACA well from the Affordable Care Act it was developed under the Affordable Care Act that the states can create one we created one in Vermont called OneCare and so the doctors who are members it's like you get on the computer program and there's no one else in the network so your information can be shared Physicians for National Health Plan is on a mission to get rid of OneCare because it's not doing anything it's just another level of administration that's taking money away from the doctors and nurses who need the money and I have a lot of information from the League of Women Voters because I'm a member and we're doing a study in Vermont right now about whether healthcare should be a public good or not and we would like to have it some people call it socialized medicine so this was this was developed so like if you go you're going to cardiologist for years then you need to go to an ortho surgeon the ortho surgeon if you're all in OneCare can look up your cardio stuff so that is that was the whole idea with sharing information do you have a question you're just touching your hat okay well sometimes there's a new one treatment services is that like the UVM comprehensive pain program I think so I'm not sure but I think so I mean up in Copley there's a chronic pain doctor yeah so that's something else that they're covering now so you call up always call up and make sure it's covered right and the doctor's office is yeah so before I have any procedure I tell the doctor to make sure the surgeon or doctor to make sure to get prior approval so I know what's covered you know the one thing you have to remember is we're supposed to get free colonoscopies every 10 years if they don't bill it as a screening colonoscopy if they bill it as a diagnostic colonoscopy you get a 700 dollar bill so you have to specify you know what you want and work with your doctor and if you don't have the kind of relationship with your doctor we can work with them and figure this out and work it out maybe it's time to think about getting another doctor if you can find one you can't find one out of one care you can't find one I tried to get one with different hospitals up here, this is Berlin and they said there are 26 people in front of you waiting for a new doctor you probably care about it so that is a problem all over all over the country so okay yes sir what do you think of the UVM plans? well a lot of people are very happy with the UVM Advantage plan so if I change from the traditional Medicare this year to UVM and then next year one to change back to the original Medicare would that be any problem? with the original Medicare I can't guarantee you would get your supplement back oh but otherwise I could do it I would do it mostly for the dental insurance yeah so the regular Medicare and a lot of people do that or they go buy a private policy through Delta Dental or Humana or one of the other companies but you got to remember with the dental policies there's the regular services and then there's the big stuff the comprehensive the fillings and the crowns and all that if I'm on an Advantage plan and I want to switch back to original Medicare I may not be able to get many GAPs from the insurance you may not be able to get your supplement back why would I be rejected? if you had pre-existing conditions of any kind yeah it's up to the insurance company at that point but usually but pre-existing of course there's not a private dental no so what was the question again? yeah so going back those sort of changing sort of conditions do I get rejected? well that depends what they are that depends what they are and it's up to the insurance company so basically there is a grace period you can just go on an Advantage plan where you can switch back it's like two months or something so the first two months if you hate your Advantage plan in January and February you can go back switch back to your old plans or if I get rejected in the Medicare plan can I then turn around and get in my guarantee coverage with the Advantage Advantage plans don't look Advantage plans and drug plans do not look at pre-existing conditions so yes you can can the only one that has a dental no they all have a dental so you want to go to the the plan details for each one to see what the one you're choosing is what coverage they have some cover the fluoride treatment some down some it's 20% some it's 40% yeah they all have so the best thing to do is to go on this to play with it or make an appointment to come visit us before you make it whenever I have someone who wants to go on an Advantage plan I show them the plan details and say this is what you have to listen yes sir when you sign up for Medicare Advantage first you sign up for the Medicare B A and B A and B then you pay your with the B you put the creaming on the shelf not the creaming you put the coverage on the shelf what do you mean by putting the coverage on the shelf basically you don't use A and B you only use the Advantage plan that you have signed up for okay so thank you you're very welcome and remember those individuals too I only have a few council on aging brochures we're running fall on them I have some on our caregiver program which if you know someone who's a caregiver he needs support you should pick up one of those I have three pages we've got three or four pages from the presentation on supplemented and on my business so help yourself thank you