hi this is Andy Thompson, the host of Life Ahead right here on PBS for Wayne and we have a very good show for you tonight if you happen to watch last week you know that our topic is about Medicare Advantage plans supplements.

Are there any changes?

Well, what do you need to know about insurance?

>> And probably already if you do have Medicare you've probably already received your booklet for twenty twenty three.

We're going to go through some of this and I have an expert in the field who comes to life head a couple of times every year about this time to clarify a lot of those things and that is Greg MacDonald certainly Greg, you're no stranger to us.

>> Your LIFE Ahead.

No, it's been fun to come.

Yeah, good.

Well, he always comes with good news and some I wouldn't say bad news but some changes people need just know good information.

>> Yes, good information.

That's it.

Now I do want you to remember that this is really your show we're just sitting here but it's your show so we want to talk about what you would like to know and you have the opportunity to do that by giving a call here at (969) 27 twenty and Greg will answer your insurance questions if you would stay on the phone and talk to a slide that's wonderful that way if Greg has any questions for you, you're right there on the phone if you're not comfortable with that, we do have a phone screener who is in the control room and she will write down type up your question that you have and send it out here to the studio on the teleprompter and then I will read it to you one way or another we're going to answer people's questions.

>> OK, let's start out by Medicare and you twenty twenty three.

>> Greg, first of all, I think people are wondering are there any major, major changes that they really need to know about?

>> Nothing major.

I mean what we find here is really pretty good in the sense that I guess the biggest thing if you're a diabetic insulin if your plan covers it are capped at thirty five dollars a month which is terrific vaccinations including shingles shots will be free.

>> Yeah.

Twenty twenty three.

>> So those are some good good changes.

Yeah.

And I don't think a lot of people know that the shingles shots are free right now.

I know at pharmacies now they they actually have signage up that says that because for so many years people had to pay extra for vaccinations.

>> That's right.

Shingles that that's a new new thing.

>> Yeah that's a nice well let's kind of review a little bit about covid we've certainly been experiencing all the many different things that have happened because of the pandemic and we're still in the aftermath of that it's all quite over yet what is covered in terms of covered by Medicare?

>> Everything everything really is I mean you can have your tests, your shots, those things are all covered .

>> So yes, if you have any questions or concerns that you might have covered or or question whether the shots are boosters are paid for .

>> They are they are so you're good and you can go get tests.

>> Yes.

Without having to pay that many pharmacies even provide at home tests which are complimentary as well.

>> And I don't want anybody to ever be concerned that if you think you have covered that it's going to cost you some money because isn't it that if you require special treatment perhaps respiratory therapies or or something those kinds of medical issues would be covered ?

>> Correct.

OK, I know good to know.

OK Greg last week we talked a little bit about eyeglasses and cataracts surely and and we were a little unsure about the stand that Medicare has and we told you that we you know, this week.

So Greg, what's the deal with eyeglasses and Medicare?

>> Well, last week you said hey, I thought that glasses are covered after cataract surgery and I said no, I was going logically with the idea that that Medicare doesn't cover vision or eye glasses.

Well, in this case it does after cataract surgery, Medicare will pay for a standard frame and lenses or cataracts.

So that is included.

>> You were correct.

And so now you and my wife know that I occasionally make mistakes.

>> Do not spread it around.

She's the one that told me you did.

>> I actually were just kidding again, you know, a lot of people are hampered or are facing a cataract surgery and just so you know, Medicare will give you will pay for one pair I think they call it standard frames and and lenses or contact lenses.

>> Correct.

Whichever you choose.

OK, all right.

Now let's talk about some of the other things that are not covered by Medicare.

>> Well, first of all, explain to people what Part A and Part B is if you're new to Medicare that might be confusing to you.

>> Yeah.

So Part A is everything that happens as an inpatient in a hospital or in a skilled nursing facility or rehabilitation after hospital stay Part B is your your doctor's outpatient facilities the are so part B is what you typically use the type of treatments that are every day so to speak Part A there's no additional cost when you turn sixty five because you get that automatic right because you've been paying for it and paying for it your entire working career.

>> Right.

Part B does have a premium when you turn in that premium for most people next year is going to be one hundred and sixty four dollars and 90 cents.

>> It went down it went down a little bit unusual situation.

>> This is I've not had this happen in my in my experience where Part B went down after Social Security went up because we had an eight point seven percent increase in Social Security usually Social Security goes up, Part B goes up.

>> This is the first time that's ever happened like that since nineteen eighty one or something.

>> Yeah, it's been a long time and really it's a function of because they they hiked the part B premium up too much last year based upon the Alzheimer's drug what the cost they thought was going to be actually turned out to be half of oh really.

So yeah they didn't have a way of actually paying back the part B premius so they just kept collecting that folks and they're crediting a little bit to this year.

>> Well let's talk a little bit about that increase in Social Security like is it going to be a lot of money for people?

>> When will we start seeing that in our in our Social Security check that extra January January of twenty twenty three.

>> Yes.

OK, so you're not going to get it in time for Christmas shopping but eight point eight point seven percent increase a lot that's a big increase.

>> However I understand a lot of people are already complaining saying that isn't in line with grocery store prices or other cost of living but exactly hey, it's something I think you should be thankful for that.

Yes.

Yeah, for sure.

OK, let's talk about some things that are not covered in parts A and B and we went over this last week.

>> I just want to review this quickly if it's the first time you're watching Greg here on LIFE Ahead and these are things that are not covered by Medicare so if you want them you're going to need an advantage plan a supplement depending on what it is.

OK, so how about most dental care?

Dental care is not covered by Medicare itself.

Preventative in some comprehensive is covered in advantage plans.

>> OK, how about eye exams?

Routine eye exams are not covered by Medicare.

>> They are covered in advantage plans.

OK not supplements, not supplements.

>> OK dentures depends on the plan.

Oh really ok dentures are here's the thing any major service is considered the advantage plans do not cover them how they define major service.

>> So I have seen plans cover dentures.

I've seen plans that do not OK all right so if that's something that you're very interested in or that you might need make sure you have clarification when you're deciding on a plan.

>> Long term care not covered by Medicare no cosmetic surgery?

>> No unless it's reconstruction like if with the mastectomy and reconstruction that is covered .

>> OK, all right.

So it depends on on what is OK massage therapy no OK about routine physical exam at your regular practitioner.

>> No not on regular Medicare.

It is covered under most advantage plans.

>> Yeah and in fact I mean I don't know you're the expert on insurance plans but it seems like most of them will give you an annual free wellness exam.

>> Right.

Medicare gives a welcome to Medicare physical your first time first time and then it transitions to a wellness visit which is, you know, just basic stuff you talk to your doctor, ask questions, get some blood pressure, listen to your heart and lungs.

But it's not a full physical.

>> Right, right.

Exactly.

Hearing aids and exams for fitting hearing not covered by original Medicare.

>> They are covered by some advantage plans most Evangeline's crosier care, retainer based medicine, boutique medicine, that sort of thing not covered at all.

OK, covered items or services you might get from an opt out doctor what's an opt out doctor?

>> An opt out doctor is a doctor who does not accept Medicare but agrees to treat you OK.

So if that's the situation if you go and and they said yes, we'll treat you Medicare will pay OK but they're allowed to charge fifteen percent above and beyond Medicare reimbursement.

I see.

And so that typically would be on the patient to pay that unless most Medicare supplements do not cover that with the exception of Plan B and Plan F talk about Plan G, you mentioned it last week and that was kind of new to me.

>> So explain what that is.

Well, Plan G is a Medicare supplement that covers everything with the exception of the Part B deductible.

So that changes a little bit every year.

Next year it's going to be two hundred and twenty six dollars.

OK, so you pay that and then as long as this Medicare covered for the rest of the year you're covered .

>> You don't have any additional expenses out.

So plan F for those people who are older and have a plan if they don't have to pay the part B deductible so there's nothing that they have to pay and that's the only difference between F and G. >> I see.

I see.

All right.

You know, I'm kind of interested in Greg's answer to this.

>> How do I pick a plan?

That's right.

for me, Greg.

I mean do I just go down this list and say oh wait a minute, these things weren't covered by Medicare.

>> This this and this are important to me.

Look for a plan that has and how do I how do I decide it all really depends on your comfort level, OK?

>> Because there's two paths you can go down Medicare supplements, Medicare Advantage.

>> Explain what each is.

OK, so Medicare supplements work hand in hand with original Medicare.

So you have a claim the claim goes to Medicare what Medicare doesn't pay it shoots off to the supplement for them to pay so the supplement is paying what you normally would have to pay.

>> OK, there's ten different plans.

They all pay a little differently.

Plan G is the what is the most popular because it's the most comprehensive plan in their Medicare Advantage plans.

The claims do not go to Medicare.

They go to an insurance company and then you have co-pays based upon the services rendered.

Well many of these plans these days are zero premium people ask well how the heck can they do it for zero Medicare is paying the insurance company to insure you and that's why they're able to to do that.

And people come to me and you know, I will enroll them and saying well, there's no premium.

How do you get paid?

Well, insurance agents get paid by the insurance company so everything's commission based.

>> You should never pay an insurance agent when you see them.

>> OK, I understand that any counseling or advice you don't you should you should not pay for any advice when it comes to Medicare like that insurance agents are compensated when they sell a policy.

OK and we're also compensated to service that policy.

So as long as you have a plan if if I sold you a plan.

>> Mm hmm.

As long as you have that plan I will receive some compensation for it.

I see.

So don't be afraid to call your agent and ask them questions.

They're getting paid to answer your questions and the service and you're not paying them to answer the phone and no, I have an office.

>> Is that right?

Yeah.

You shouldn't have to pay anything like that.

OK OK so yeah if somebody if you find an insurance agent that wants to charge you for that to somebody else walk out the door somebody else.

>> We do have a phone call here and let me see who this bath OK bath thank you by the way so much for watching and for calling.

>> She says this plan cover annual physicals and the answer Beth is no that doesn't it it pays for the first one which is what Medicare covers when you first come into Medicare after that it is simply wellness visits.

>> The supplements will not cover anything that Medicare itself does not cover .

So an advantage plan offers extra services for you to work with them supplements don't they just go right hand in hand with the original Medicare so you're not getting anything additional to that original Medicare offers.

>> So then to begin with if I understand this correctly, the first thing you have to do is decide do you want something extra that's not covered by Medicare?

Do you want some other kind of coverage and then which kind of supplement or an advantage plan and then within that we say I would decide I want an advantage plan plan every insurance company is going to have several different plans to choose from.

>> Correct.

How do I pick which.

>> Well, right here's here's the process that I go through when someone comes to me I ask for their drug list and I find out what drugs do they take and then I'm able to look at the plan formularies and say OK, which plan minimizes their drug costs?

And then we look at OK, who are your doctors?

Which doctors are in the plan's network?

If if you are doing an advantage plan, if you're doing a supplement that doesn't matter because you're able to go wherever you want to go whoever except you.

>> But the when it comes to the drugs you need to know that to find out either what drug plan you're going to be on or which advantage you're going to be on and then after that it's slight.

>> It's OK. Yeah.

Where are you traveling back and forth the winter in Arizona or Florida and coming back you stay here.

What are you what kind of services are you looking for advantage plans have basically they come in a couple of different flavors.

There's HMO's which means you have to stay within your network.

There's HMO policies which allow you you have to stay in their network except for a couple of instances they let you go out and there's PPOs which allow you to go out of their network but you pay more when you go out although the insurance companies will still pay do most plans have you pay for specialist?

>> Yes.

OK, all right.

So not to be surprised, I know a lot of plans these days on if we're talking advantage they don't have charge for primary care about doctor visits.

OK, that's typically zero eight days.

Yeah but there is a charge for specialists and it varies between plans.

>> OK, Robert has just called in and I can Robert thank you as well as for watching us here this evening.

Robert wants to know what the difference is between Plan F and gee I knew that would be confusing.

>> Right.

The only difference between plan F and plan G is that Plan F pays the part B deductible.

OK, plan G does not that is the only difference between the two plans.

Pretty simple, pretty all right good to know.

>> OK, here's another question coming in right now why can't someone under sixty five by a supplement or an advantage plan supplements are restricted for a long time you couldn't buy any supplement in Indiana right now you can get plan A OK and that's not to be confused with party planning is a separate plan which covers primarily hospitalizations.

>> It is expensive.

You can always buy an advantage plan as long as you're on Medicare.

OK, so Advantage plans are open to people under sixty five OK and in my opinion they're a far better deal than a Medicare supplement when under the age of sixty five now under sixty five hundred sixty five.

>> Now keep in mind when you first are eligible for Medicare and you can pick up a supplement they ask no health questions right when you're under sixty five and you can't get a supplement at that point I can you get one eventually and the answer is yes.

When you turn sixty five you will have another enrollment period where you'll be able to switch from an advantage plan to a supplement no questions asked.

>> Got it.

Got it.

Well let's talk about timing actually is pretty important for us to be talking about this time of the year.

Are there certain periods I know there are.

>> You'll tell us what they are where you can change your plan and all in the plan.

>> How does that work?

You're so right now we're in the annual enrollment period that runs from October 15th to December 7th and that's the time when you can change pick up an advantage plan change advantage plans, get a drug plan if you have a supplement and you want to try and advantage plan, this is the time to be able to do that.

>> OK, now we have it another enrollment period that happens from January one to March 30th and this is for advantage plan people only.

OK, and this is if you're an advantage plan you get in it and you start it and you don't like it.

It's not working for you for one reason or another.

You do have an opportune to switch to another advantage plan within that same insurance company.

>> No go to any company you want OK?

>> Any company you want but you have to do is advantage plan to advantage plan or advantage plan to original Medicare and then you can pick up a drug plan you cannot change drug plans during this period of time.

OK ok it's advantage plan only that you can make these changes ok good to know and if there's other enrollment periods if you move out of the area those are things if you have emergency sometimes those things happen where we can change so yeah there's different times.

>> You know a couple of years ago I was going to change plans within the same company I had been with for a long time on an advantage plan and I called a number that was on their website.

>> It was wonderful.

I mean the customer service person spent a long time with me on the phone explaining the different plans, asking me questions to help be able to determine what my needs or requests were.

>> So a phone call is not out of the question at all because not everything's going to be in here or in a booklet.

>> Correct?

OK, yeah.

Don't be afraid to call customer service on any plan that you have if you usually you can get some pretty good answers if you're still not sure, call your agent Ryan, ask them questions and if they ask what they're there find out.

>> Yeah, exactly.

They can find the answer for you.

>> Like Greg said, that's what they're there and sometimes sometimes I have had a person in my office today and she told me what she paid for something I'm going you shouldn't have had to pay that much.

>> No.

And she said Well what am I supposed to do?

And I said bring bring us the obese explanation of benefits and the receipts you paid and we'll take a look to see did was there an error in the billing here because sometimes they do they make mistakes and that happened.

Yeah it happens yeah I found that out.

OK, here's a big question for Greg that I find very intriguing right now probably all of you if you watch TV at all are seeing an awful lot of commercials right now from different companies and a lot of times they'll use the celebrity to type voice or act out the commercial.

>> You know, calm down, calm down.

They'll have a big phone number and in print, you know, you might be eligible for dental vision and hearing what one should we believe and what one should.

>> We can't be hesitant.

Yeah.

Keep in mind all of those commercials are designed for one thing and that is to make you call in OK, but when you call it it looks on the screen and by what they say you assume you're calling Medicare.

>> No you're not you're calling a call center in their job is to to get your name and permission for an agent to call you.

That's all that is.

And they're talking about advantage plans and there's a lot of carrots out there that for example and we talked about hearing vision.

>> There's also the part B payback where some plans will actually put money back into your part B so you're not paying as much for that.

There are some plans like that.

Most of them are designed for dual eligibles which means you have Medicare, Medicaid, not all.

There are some plans, some payback plans for those not you have to see whether that's a good plan for you or not.

Yeah, OK.

But yeah there are there there but all that is is is a a carrot to get you to call them so they can have an agent call you.

>> OK I'm glad that you clarified that because it's you know it's really confusing and when you see a celebrity right away you think oh my I must believe them because they're famous.

Well they're also paid a lot of money to make that commercial to get people to watch and to get people to call that number.

>> So be very discerning.

>> Is that a good way to put it?

Yeah.

Yeah.

Just just figure any of those things that are out there for commercials are all designed to get you to call an agent.

Yeah.

They give you permission for actually for an agent to call you what should we do instead of calling that big number?

>> Well you can call and get information if you choose but keep in mind any information that you give them they will be calling you back and in my opinion humble opinion, there are many good local agents in our area.

>> Call one talk if you're not sure who to call to talk to some friends who you have an agent that you like, what's your name and give them a call .

It's so much easier to have be able to come in and talk with somebody rather than just do it on the phone all the time.

>> OK, we only have a minute left but here's a question from Janet.

She said If plan after have similar coverage why would you get G quick answer less expensive.

>> Bottom line bottom line it's usually a lower premium F does has a limited number of people in it.

>> It's going to be shrinking costs are going to be going up on it.

You're going to have higher cost increases with F than you are with G right now.

I even people who are eligible F I suggest.

>> Excellent excellent advice and again our expert here on insurance Greg MacDonald, he's always with us a couple of times every year at this time and you're going to see him in November a couple of times as well.

>> Meanwhile, Greg MacDonald, thank you for your expertize and information this evening.

>> My pleasure, Sanjay.

Always good to be with you and for the rest of you don't get covered .

>> Don't get the flu.

Stay safe and stay healthy and we'll see you next Wednesday night at seven thirty by