Direct Connection: October 7, 2019

Welcome to “Direct Connection”.” Tonight we connect you with
information to get the most out of Medicare.
Tens of millions of people are covered by the program, and
there may be just as many questions about how it works.
Joining us is Sherry Kolbe. She is the ship program
coordinator for Baltimore county county.
Thanks for being here.>>Sherry Kolbe: Thank you.
>>Jeff: Ship is a program, it’s around the state, helps people
with Medicare.>>Sherry Kolbe: Right.
Actually it’s national. It stands for state health
insurance assistance program, and I always I kid, no, I don’t
sell state farm insurance. What I do is educate people in
Baltimore Ukraine about Medicare Medicare, and literary there’s a
me in every county in the nation nation.
>>Jeff: All right. Let’s start with education.
We’ll do the ABCs of Medicare except there’s also D oh A, B
weeks, C weeks, development DP let’s starts with A.
That was original Medicare.>>Sherry Kolbe: Ocular Medicare
is Medicare A and B, B being the hospital piece, A the medical.
So what Part A covers is if you’re lift admitted to the
hospital. If you’ve been admitted for
three mid nights, you’re trans I period to skilled nursing for
some rehab. If after that you need PT, OT,
speech therapy, pays for that in the home and hospice.
Medicare Part B is what pays for the doctors, whether you’re
admitted to the hospital and it’s the surgeon, the
anesthesiologist, the doctor the in office,TER, that’s all paid
by Medicare Part B which is also going to pay for things like
blood work, all the out outpetitioned, x-rays, surgery,
your — outpatient 1 you’re pneumonia shot, your flu shot, a
lot.>>Jeff: Let’s hold off on C for
a second and talked about D which is relativity recent.
>>Sherry Kolbe: Week. Medicare Part D just started in
2006. So it is the new kid on the
block. It is how one gets Medicare
prescription drugs because your webbed white and blue Medicare
card, A andB be will noting paying for the routine drugs
that you get at the pharmacy. You have to have the Part D plan
for that. And right now we’re gearing up
because open enrollment is October 15th to December 7th
December 7th, and that is an opportunity to examine whether
your current Part D plan is really the best for you for the
next year.>>Jeff: So what I’d like to dig
into D in more detail. What is C?
C is your Medicare health plans or your vag plans or if you want
did vag advantage or the Medicare HMOs
or PPOs. All those terms mean the same
thing and what an advantage plan is it’s a substitute for
original Medicare. So if you elect to get an HMO,
you would literally putter your Medicare card in a taur and,
let’s say one of them, for like Baltimore county we have CIGNA,
health spring, Kaiser, and hawk hawkins.
So let’s say you pick Hopkins, and then you would use that card
for doctor, hospital, lab, x-ray x-ray, and the pharmacy.
That company is a private plan. America pays them to take care
of you. But — Medicare pays them to
take care of you. But the rules are different than
with original Medicare which makes it a tad confusing.
>>Jeff: Do most people that you deal with wind up getting one of
those plans?>>Sherry Kolbe: Actually, they
are more popular in more states than they are in Maryland.
In the state of Maryland and like Baltimore county, which is
what I deal with, usually people will opt for original Medicare
because you can go to any doctor in the nation.
And then they will select a Medigap, a Medicare supplement
plan to fill in the pieces that Medicare does not pay for.
>>Jeff: Okay. So I’m already confused.
But I haven’t asked about Medicaid yet.
The difference between a Medigap and a med care advantage is what
what? Medicare advantage is what?
>>>>Sherry Kolbe: They’re
completely different pieces insurance.
If you want to be a original Medicare to go, as I said, to
any doctor in the nation, no referrals, okay, but there are
are — Medicare doesn’t cover 100%.
And if you’re someone that wants to know pretty much what you’re
going to spend for your health care, you can get a Medicare
supplement insurance, and there’s literally an alphabet
Suif them where everything is covered to — soup of them
wherever is covered and that has the highest premium.
The premium goes down if you’re willing to have out-of-pockets.
You show your Medicare card, your Medicare gap and you’re
pretty good. But they’re expensive.
I mean, at 65 an F Medigap might cost you $170 a month.
Versus the advantage plans, they’re much cheaper, you might
have a zero premium, $25 premium premium, but every time you do
use it, you pay out of pocket juice lick with original
Medicare so you might pay $5 for your primary, $50 every time you
see a specialist.>>Jeff: You’re giving up
reflect.>>Sherry Kolbe: If you’re in an
HMO you must go in network, not just for the doctors but for the
hospital, the labs, x-ray people people.
Everybody’s got knob in network. The — got to be in network.
What’s the advantage of an advantage plan?
If you’re on original Medicare and just using that red, white
and blue card, you can go anywhere, but& there’s always a
but, there’s no out of pocketMI cancer, chemo, radiation,
surgery, you’re going to have a Mammoth bill.
With advantage plans there’s an out-of-pocket cap, and for mosey
of them it is $6,700.>>Jeff: Interesting.
>>Sherry Kolbe: So if you have the same cancer, chemo,
radiation, you probably will pay $6,700 out of pocket but you’re
not going to pay $10,000, $20,000, 30,000 orders more.
>>Jeff: Let me remind your viewers if you have a question,
any question all the about Medicare, we have an expert here
for you. Give as a call.
We’ll have the number up on the screen.
You can also Mei your questions. email address is
[email protected] And to quickly clarify the
confusion about Medicaid and Medicare because the names are
kind of similar except for a couple of letters, Medicare is
for older folks, Medicaid is for poorer folks.
Or disabled folks.>>Sherry Kolbe: Medicare is for
people who are 65, but a third of the people I talk to are not
65. They get Medicare because they
successfully applied for Social Security disability.
So the 25th month they get a check, they come on board
Medicare. Also people with end stage renal
disease can be pretty much any page fourth month dialysis or
they get a kidney transplant they come onboard Medicare.
But your Medicaid an income- income-based program.
If you’re not on Medicare and once you’re on Medicare, it is
an income asset-based program. So, yes, it is the poor — well
well –>>
>>Jesse Pippy: And they changed that with Obama compare the
Affordable Care Act. They wideened the standard of
who qualifies for Medicaid.
If somebody is on Medicaid, they’re 64 years ode, they turn
65, what happens?>>Sherry Kolbe: Well, what
happens is that the income level is fairly — I’m not sure
of it exactly. Let’s say it’s $1,300, and
there’s no asset limit. Doesn’t matter what your seaters
seaters. You can get this medical
assistance. You come onboard Medicare, the
income level is $350, not $1,300 $1,300.
And assets, uk only have $1,000 or $2,000.
That means people who were on medical assistance hadell all
their medical bills paid for, paid valentines for their drugs.
Now they’re on Medicare and many of them will not continue.
The seniors that have medical since are those who assistance
are those who are on SSI which means
their income is no more than $771 per month for an individual
individual.>>Jeff: Let’s get to the phones
phones. A lot of callers for you.
This is cilia innaire fax county county.
Thanks for the call. Go ahead.
In Fairfax county.>>I found out that 65 is
Medicare, but I’m also cultured my husband’s insurance.
He’s a government worker and so I didn’t sign up for Part B, and
it’s kind of confusing about
whether or not I should have — because I have — I’m not —
[Not Audible] With what we have.
>>Sherry Kolbe: At 65 there’s one group of people that does
not need Stein up for Part B and working about the penalty.
So you’re the spouse, and so your husband is actively working
working. He has group health insurance
through his employer. The employer has more than 20
people. So in that situation, you do not
need to sign up for B until he is going to retire.
So a couple months before he retires, the two of you would go
to Social Security, and then you would be signing up for the B,
his employer would verify that you had insurance from 65 until
whenever date this is, and that would prevent you from having to
pay a B penalty.>>Jeff: Similar question from a
couple of emailers. That’s not it.
If you’re 65 but still work full full-time and have insurance,
what do you do? Do I have to sign up or pay a
fine?>>Sherry Kolbe: Okay.
As long as you’re actively working, group health insurance
through work, employer is has more than 20 people, then what
we usually say at that point is you can sign up for A, why not?
If you worked for ten years you or your spouse in this country,
it’s going to be free. And then you would not sign up
for B because if you have group health insurance through the
employer, B costs money. It’s $135.50 a month and you’re
simply not going to get $135 worth of benefit from it so you
don’t sign up for B until you’re going to retire.
The one time you would not sign up for Part A at 65 with this
work scenario is if the insurance through the work is a
health savings account, an HSA. You cannot be on any form of
Medicare and contribute to an HS HSA.
So in that circumstance, you would not sign up for A or B at
65.>>Jeff: Back to the phones.
Prince George’s county. This is Joseph.
Joseph, what’s your question?>>Oh.
My question is if you’re 65 and you’re still working full-time,
do you have to sign up for any Medicare at all?
>>Jeff: Very good. We must have a lot of people age
64-1/2 watching tonight.>>Sherry Kolbe: Et people get
nervous because they wonder if they are going to to a pay a
penalty. You do not have to sign up for
“A” unless you and your spouse worked ten years in this country
country. We say “sign up for it worsening
student “because it will be secondary, you may or may not
get some use. But if you don’t sign up for “A”
unless you’re going to retire at 68 or 70 or whenever that is,
you can sign up for A or B then. I’m beyond age 65 and I signed
up just for “A”.” I went online SS SSA and it took
me a couple of minutes to sign up
for “A” and I got my Medicare card with just “A”.”
I cover my spouse. He had gotten a Medicare card
which had A or B at 65. He turned it over, declined B,
sent it it will back. So we now have cards that just
say Medicare A because I am still working and my group
health coverages is our primary insurance.
>>Jeff: Sure. The in in your job you
talk to people about this all day every day.
>>Sherry Kolbe: Correct.>>Jeff: Do you see any trends?
Do you see more people doing Medigap or advantage or — is
there any sort of shift going on in how people deal with the
complexity of Medicare?>>Sherry Kolbe: In Maryland, I
mean look at Baltimore county. We only have three companies
that sell the HMO dollars,MOs. The advantage plans.
If you were in Florida, from the people who movement here back to
Maryland, they all have. Pennsylvania, New Jersey, New
York, they seem to buy Medicare advantage more than is done in
this state. I think we would have more
choices, more companies if more people were going that route.
So I think it says something, that that is not — you know,
more people stay with original Medicare, and if they can afford
it, they get the Medigap to go with it.
And if they can’t do that or there are people that have the
financial wherewithal to buy Medigap but they don’t really
want to pay for and it so they then go for the Medicare
advantage plans.>>Is Georgia fra is outlier or
are we the outlier?
>>Sherry Kolbe: I don’t know. I gather at least 33% of seniors
do have advantage plans. And I think there is an uptick
in that number nationally.>>Jeff: Let’s take a phone call
from Montgomery county. This is Katey.
Thanks for the call. Go ahead.
>>Hi. If you’re in Medicare — I’m 67
67 — and you’ve been hospitalized, how do you opt out
of going to a rehab center in lieu of getting in-home care
instead ?
Shenk well, typically — the doctor is the one who is suggest
suggesting you go to a skilled nursing facility.
The purpose of that is for you to get treatment on a daily
basis. If you get care in the home,
let’s say maybe physical therapy you will not get it every day.
So it would be you having a conversation with your doctor.
If you really don’t want to go to a skilled nursing facility
and you want it at home, you would be aware that you’re not
going to get this service every day.
>>Jeff: Prince George’s county. This is Stanley p the.
Stanley, thanks for the call. Go ahead.
>>Yes how you doing? I will be turning 65 next June.
I’m retired from the federal government, and my health
insurance is wet nah and I pay quite a bit for that, $400,
close to $500 a month. I have a high option.
I’m just wondering once I get Medicare, should I or would I be
able to drop my previous insurance, health care insurance
or should I keep that or maybe get option insurance with the
insurance I have now?>>Jeff: Are you retireing at
the same time or plan to retire a
little bit?>>No, I’m retired completely
been retired for four years.>>Jeff: Good for you.
>>Sherry Kolbe: I would caution any federal retiree E.e, do not
crop your insurance. If you drop it, I don’t believe
you’re going to be able to get it back.
There are other options with the federal government that maybe
are not quite as pricey as the one you’re on.
You really want to explore your options before you do anything.
I would highly recommend speak speaking to a ship counselor.
Now, we have different states here.
If you just Google the state health insurance assistance
program or ship, you can find the number for your state and
then they’ll drill down to your county.
To really speak with a counselor M. lor before you make any major
decisions.>>Jeff: And his HR department
or whatever it’s called in the federal service.
>>Sherry Kolbe: OPOPM. Definitely is there to help also
also.>>Jeff: In the Medicare world
is there anything such thing as a pre-existing condition?
Do people signing up for it or changing plans have to worry
about that?>>Sherry Kolbe: We don’t run
into the preexisting issue so much anymore first of all, if
you’re Gecht Medicare itself you don’t have worry about
preexisting. If you’re gecked Gecht a
Medicare advantage planning, the only pre-existing they won’t
accept you for is end stage renal disease.
With the Medigaps, the type to buy them, there’s a guaranteed
issue w period called open enrollmentment for Mehdi gaps.
The first six months you’re on Part B.
If you don’t get the Medigap at that point, from that little six
six-month period onward and you want to have a Medigap or change
Medigap, they will do what they call underwriting.
They’ll look at your age and health and they did not have to
sell to you. It’s up to the underwriters what
they will sell a and what they will charge you.
The it’s very important if you want to get a Medigap that it’s
done within those first six months.
Certainly down the road if you maintain good health, you still
main able to get a Medigap.>>Jeff: Let’s go back to the
phones. Calvert county.
This is Robert. Robert, thanks for the call.
Go ahead.>>Yes.
Let me first of all say you always have these great topics.
>>Jeff: Thank you.>>My question, and I don’t know
if this would be appropriate for your guest to answer, but my
doctor said that he thought — I’m a member of a new discolony.
Okay? And — nudeist colony and my
doctor said he thought that would continue to be a very good
therapeutic physically and mentally for me but he wasn’t
sure, he looked it up but he wasn’t sure if it was covered by
Medicare, and I am over 65.>>Jeff: I’m sorry.
If what was covered? You mean your membership?
>>Membership, yes, for the nude nudist colony.
>>Jeff: If it is, your member membership is going to go way up
up. Let’s get an answer for you.
Thanks for the call. Appreciate it.
>>Sherry Kolbe: Medicare does not pay for acupuncture.
It does not pay for massage.>>Jeff: So the nudeist colony
is going to be a tough sell Shenk
that’s not going to happen. There has been a little bit of
advancement with acupuncture if there’s a certain study being
done, Medicare may pay for that, but Medicare is not that
advanced in those areas.>>Jeff: You have in the work
you do, people volunteer, right? This is your job.
You have volunteers .
>>Sherry Kolbe: That’s correct.>>Jeff: It seems like a
awarding thinking. You have this big booklet here.
For anybody who has figured this all out, it’s a nice Wye way to
help people.>>Sherry Kolbe: I’m the only
full-time person in the office so my staff, I have 12
volunteers that do year of had round counseling so they can
talk about anything. We’re talking about tonight.
And it is, some of them volunteer ten, 12 years so that
must mean they really do compliant get a lot of reward
from it.>>Jeff: That’s great.
Let’s go back to the phones. Cecil county p this is Frank.
Frank, thanks for the call. Go ahead.
>>Yes. I’m 78 years old, and I’m a
Vietnam vet and I have 100% disability.
Should I still keep by Medicare A and B?
>>Sherry Kolbe: Well, if you’ve kept the — the “A”,” yes,
because you would not be paying for that, and the “B”,” if you
have kept think it long, still keep it.
What happens, though, sometimes I’ll get phone calls from people
who maybe are their 80s, they’re not able to drive to the
VA center anymore to get the health care, so they want to go
to a local doctor around the corner, and they will not have
that coverage unless they have Medicare part “B”.”
Also, when you go — if you go by ambulance to a hospital,
which is non-VA, you do not know for sure what the VA is going to
cover websites up to them whether they cover all, half or
nothing. So it’s best, particularly at
your age now, to keep paying for the “B”.”
>>Jeff: Here’s an interesting email from a viewer.
Wants to know if Medicare will reimburse if the surgery is done
abroad. So medical tourism, people go to
foreign countries to get the procedure done cheaper.
You need a doctor who participates.
>>Sherry Kolbe: Medicare does not pay for care outside of the
United States.>>Jeff: So that brings me —
two things. What do do you if you’re
traveling? And two, in terms of within the
United States, how many people don’t participate?
Do most doctors –>>Sherry Kolbe: I do not know a
percentage. Most do.
There are some doctors who have literally signed on the dotted
line with the center for Medicare and Medicaid service
they won’t want to be involved with Medicare.
They’re an opt-out doctor and if you go to one you pay 100% of
the bill. As far as travel, now, — okay,
if you’re in a ship, a cruise ship within territorial waters,
that might be paid for, but if you’re travel, let’s say, to
Europe, Medicare is not going to pay for care in Europe.
Now, some of the Medigaps do have a foreign travel component
to them. It’s only for the — for
emergency care, the first 60 days, and there is a deductible,
and it’s really a nominal amount of coverage.
Anybody who is traveling really should be getting travel
insurance.>>Jeff: We’re 22 minutes into
the show. We haven’t been able to stump
you yet, which is recognized by our viewers.
This viewer wants know is there a website that lists people like
your guest for other counties in Maryland.
We talk about Baltimore county, but every county has some
assistance for people Shenk in Maryland the phone number for
the state is — I have it right here — 824-33-4225.
So that’s 1-800- 243-3425.
Now, that’s for Maryland that will give.
— each state has a ship. It might not be called ship in
Virginia, but if you truly Google state health insurance
assistance program, you’ll get the state number and drill down
to the counties.>>Jeff: We’ll do that number
before we go off the air in a couple of minutes.
Anne Arundel county, phone call from David.
David, thanks for calling. Go ahead.
>>How you doing. This is David from Anne Arundel.
>>Jeff: We’re good. Thanks for the call.
>>Thank you. Economically, when you first are
eligible for Medigap or Medicare advantage, what would be better?
Number two, if you need prescription drug coverage, of
course, you’ll get “A” and “B” when you pay the $135.50.
Part “F”,” what is the advantage of taking that versus part “C”
and “D” or “C” or “D”?>>Jeff: Thank you very much.
I didn’t get it.>>Sherry Kolbe: First of all,
if you’re on original Medicare, you have to have prescription
coverage. Whether it’s a retiree health
benefit, you’re getting through it the VA or you have to get a
Medicare prescription drug plan. If you don’t have drug coverage,
there is a penalty. It’s nominal, 33 cents a month
but it does add up and you have to pay pay it whenever you
ultimately do get a drug plan. Now, what was the — oh, —
>>Jeff: There were too many letters near to keep track of.
>>Sherry Kolbe: As far as the money goes, many people who can
afford to get a Medigap, get it. The problem — and right now “F”
is the most comprehensive Medigap, it pays for everything.
People brand new to Medicare in January turning 65 will not be
allowed to buy the “C” or the “F” because they cover the part
“B” deductible. So anybody turning 65 in January
will not have those options. They’ll be getting probably the
“G” Medigap where you just pay the “B” deductible and then
everything else is covered. With the Medigaps, they — most
of them are attained age rate. Price goes up as you get oldery.
So you might start out $150 at and I’ve and at $85 be $300 or
more per month.>>Jeff: Let’s end with a
question that I think we can give a quick answer to.
This is an email from Tony. Does Medicare pay for cataract
surgery?>>Sherry Kolbe: Yes.
>>Jeff: Perfect. Before we go, and we may have
confused people with a lot of stuff, is there one big mistake
that you see people make over and over?
And I just have a couple of seconds Shenk one of them is if
they do have a Medigap being aware of that first six month
window. Whether you’re 65 when you get
“B” offer 80 when you getB.>>Jeff: Sherry col best ship
program in Baltimore County. It’s a it’s been great.
Thank you for being with us for “Direct Connection”.”
For all of us at MPT, have a great night. p

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