it's another sign of fall that we're all hearing and seeing more about Medicare in the annual open enrollment period whether you're reviewing your current Medicare plan or are evaluating coverage options for the first time the state health insurance assistance program is here to help with free unbiased health insurance information and that includes our conversation on this edition of Prime Time.

>> And good evening.

I'm Bruce Haines.

With us this week are Paul Thier of an Art Jackson.

>> Two of the more than 400 volunteers with the State Health Insurance Assistance Program or SCHIP they are counselors across Indiana who are ready to help seniors evaluate which Medicare supplement programs are right for them.

>> So our guests are here to help you so you can join in with questions and comments the numbers right there on the screen as we welcome Paul and Art back to the studios.

>> Gentlemen, thank.

Thank you both.

Yet one easy question probably with a difficult answer perhaps is the one that starts with how does a person decide which road to go down when you say OK, it's time to join Medicare?

>> I have traditional Medicare and Medicare Advantage.

How do I GPS myself from this from this intersection?

>> Let me start with you.

Well, as you mentioned, there's so many options now and so many difference in plans.

So what we do we encourage individuals to first want to make sure their doctor all professionals in those plans in their particular player they ought to choose for instance, they want to make sure that medication is in the plan.

These are individuals that are looking at Medicare Advantage plan and if that just were to return to Medicare, they still have to have a Part D plan and same thing with the Part D plan.

You want to make sure all of your medications are being covered in that Part D plan because if not you have a surprise.

There is a lot of marketing that goes around the information understandably in America today about now Paul, how do we how do we sift it out of you know, to to help understand what my roadmap might want to be advantage or the traditional approach?

>> I've always looked at it as the matter of whether to choose let's say a Medicare supplement versus a Medicare Advantage plan is sometimes based on your budget because the supplement plans will charge you more for premiums but they will pay more so it can be a trade off as to what how your budget ends up in your health could be a factor in that you may decide that you're better off with one versus the other if based on your health and your tolerance for risk, let's call it a supplement.

We'll cover for what it what it says it will cover it if it says it covers part B deductibles and part A deductibles and co-pays then you're you can be sure sure that those are paid but the one failsafes that the Medicare Advantage plan has is that they do have coverage limits your you can only pay so many dollars in the course of a year and then you stop paying because you've hit the coverage limit and so it's a there is no one answer for that.

>> This is another sign of many mailboxes around the northeast Indiana and northwest Ohio southern Michigan area have been receiving the cover page of this publication.

>> It is a bestseller about now home delivered without any you can really get lost in the pages of this but it's a tactful way of I guess trying to like a textbook find a way through things.

>> Yes, it is practically anything you want to know about Medicare is in that book.

If individuals have problems that's in what he or she sees they always can give us a call and we have now what Segway?

>> That's that's awesome.

Go ahead.

And one nice thing about the Medicare book is that if you have Medicare A and B that's what you all you have you can go to the part B section of Medicare and you and you can look up to see for example, how often you can get a colonoscopy, for example, and you can look to see what coverage there is available and perhaps there are some restrictions.

So that's one nice advantage and that part of it was what I described on Medicare Part B cost is toward the front of the book.

I can give you a page number but it is there if you need help here please give us a call.

>> We'll be glad to walk you through it.

In a sense it is kind of like going to class but in a good way because you will always pass when you stop by the classroom that's known as SCHIP and here in our viewing area there are several counseling sites available and we'll have that information up on the screen so that appointments can be made and there's you don't have to wait for the enrollment period to pick up the phone and call.

>> That's correct.

And one that need assistance thinking about making a change if they're just new to Medicare.

Give us a call to that number three seven three seven nine five two and we are we would rather have everyone come out on a pointless that won't be two or three people trying to get in at the same time.

But we are open at site on three.

We are open Tuesdays and Wednesday so we'll be glad for anyone to give us a call and we will return that call and make an appointment for you and another point to underscore as well is this is free.

Oh yes.

And it is statewide and you are also Switzerland.

You are neutral as to whether one goes down one path or another path, right?

>> Yeah, we don't sell anything we tried to give the best advice we can based on the individual's needs and and you'd be surprised how many different varieties of needs there are out there.

We try to tailor our presentation to the individual based on their specific case and hopefully we can give them good advice and lead them in the right direction without telling them here's what you need to do and here's where you sign and we will sell anything .

>> We just provide advice and the best thing folks are bringing with them maybe the handbook but they're just bringing themselves in what questions they may have written down I suppose.

Yes.

One thing we tell make sure they bring a list of medication because if you go from one plant to another one, maybe one plan will cover a particular medication but the other one doesn't.

So that person have to make sure they bring the medication so we can give them all the best information available so they can make a decision which is a great lead into one of the major change areas going into twenty twenty five related to Medicare changes.

And we'll we'll start with the prescription drug one.

This is big information here I believe it is for what's going on there.

You know the Information Reduction Act included the two thousand dollar limit on prescription drug coverage for next year and the two thousand represents the maximum that you can pay in the form of deductibles and co-pays for next does not include the premiums but deductibles and co-pays are capped at two thousand dollars and and after we show on there on a screen you see a maximum deductible of five hundred and ninety dollars.

The plans can really put whatever number they want to there as long as it's less than five ninety and I've seen that quite commonly now that I've had a chance to look at the plans and also the co-pays subsequent to working your way through the deductible don't have to be twenty five percent exactly but it has to average out to that number.

So the the key number in that third paragraph is the two thousand dollar number if you do the math on that six twenty to thirty that's mentioned and factor into the first the first five ninety comes out of your pocket and the remainder is at twenty five percent.

Add that together it's two thousand dollars but your your results will different be different in that and as a result versus favored coverage gap or donut hole is gone.

It's history and this is no longer a part of our vocabulary anymore.

>> That's very interesting.

Take the and I believe we have info on this as well that this Medicare supplement the additional changes that that we have to share for that to disappear that was always a tough one to try to explain and why they called it the donut.

All right.

Oh so that is no longer I was struck by this information from AARP that people with Medicare will have access to an average of fifteen standalone Part D plans in their area and I think for a Medicare Advantage plan it's like thirty four different providers or plans or forty in the low 40s I saw another figure and this is the counseling in in Medicare counseling.

>> It's how do you divide them all up and then try to you know pick a number from one to ten.

How do you and these choices is for Allen County because the Cape Cod may have more may have less because not all counties counties carrier eighty.

>> So one thing about I want to back up a little bit.

Yeah.

On drug costs school now a person they got to meet at five hundred ninety dollars maximum deductible OK maybe they don't have the money to January they need their medication so now they can call and have a level how to spread it out the whole year all costs have to have medication every day and it can vary from month to month depending on what medication you but you're not worried about.

You got to put down so much money to get your medication once you sign up sign and plan that there's going to be Lova so you can be able to get your medication whenever you need it.

>> That is worth underscoring.

Absolutely in the way that works is that once you sign up for this Medicare prescription payment plan the you don't pay anything at the pharmacy when you pick up your meds.

Correct.

And that the your drug plan pays the pharmacy and they the drug plan then in turn they they will bill you monthly for your one twelfth of one eleventh of of that your portion the first month is not as I just described but once you get past that and it's simply the the balance that you owe the insurance company divided by the number of months left in the year.

And so if you have especially if you have drug costs that are heavy in the first part of the year, this may be a good plan for you if it's optional, if you're a visual learner like I am, you'll you'll appreciate this as we would move ahead to the image regarding Medicare choices.

It's a flowchart where you'll see where the Medicare Part D drug plan fits in where the Medicare Advantage plan walk us through, gentlemen, what what we're seeing here on the screen related to the comparing and contrasting of Medicare and Medicare Advantage.

>> OK, everyone has Medicare once every six to five million Medicare Part not for individuals.

They have to decide whether they want to go with the original Medicare or Medicare Advantage plan the original Medicare you have to have a Part D and his necessary to have a Medicare supplement is not mandatory.

But I would suggest someone goes that route, have a Medicare set because that picks up most of the money that you are responsible for because you know Medicare originally Medicare's 820 Medicare pays 80 the individual responsible for 20 all depending on what plan supplements you choose to pick up that 20 percent.

Now if you go the other route said well I want a Medicare Advantage plan because they have more option like vision here which Medicare doesn't cover .

So you go with Medicare Advantage plan and one positive thing about Medicare Advantage most of them include a drug plan but you cannot have a supplement with the Medicare Advantage plan.

But the good thing you have a maximum out of pocket that you're going to pay for all of your health care needs during the year.

It might be it's safe to go in the hospital and you might save and you have a procedure was one hundred thousand dollars under the original Medicare response of a twenty thousand unless you have Medicare supplement but Medicare Advantage the same procedure a hundred thousand dollars well your maximum out of pocket may be only three thousand dollars a four thousand dollar and that's all you have to pay so that's why some people choose a Medicare Advantage plan over Erina Medicare.

>> I like the explanation and I'm particularly grateful for this next image because it walks us through a checklist of of what is probably again another way through the evaluation process, through open enrollment in particular and there is at least a reasonable amount of time for that.

et's put the checklist up the open enrollment period you see the dates there October 15 to the 7th of December.

>> So right there before us so different things going on and probably job one is to let your primary care provider know that you're getting ready to explore all this.

Yeah, and it's always a good idea to make sure that your your primary care doctor, all your health care providers are in that what the network of the plan that you're choosing or considering and make sure that your dentist is part of that equation because Medicare Advantage plans typically will cover dental.

So that's part of the of the research that you'll be wanting to do beforehand.

You'll be wanting to look for a plan with low copay maximums and remember that if you go outside of the network the copay maximum jumps up to as high as I've seen I think fourteen thousand dollars this year whereas typically it's more ten thousand or under four.

It depends on on the plan you choose going with it go drilling into dental and no pun intended there you'll be looking at what is that plans coverage for the non-routine items the cost items such as bridges and crowns and and extractions and see if your plan covers it at what level water is there copay maximum that they all seem to impose and if you travel take a look at what is it that plans policy .

If you need non-emergency care out of state you'll be wanting to have that covered by the plan you choose and I also understand if you travel abroad all that's a whole different conversation altogether different conversation altogether and there is some coverage if you have a Medicare supplement they do provide some coverage but but the beyond that it's yeah.

It's another matter altogether .

Yeah, exactly.

One thing I would like to be sure we include is the information regarding low income assistance.

This is particularly valuable because it needs to be sure that it is a service that is as inclusive as possible right.

I think if he was accustomed to Medicaid and what they can receive but the other plan, the Medicare savings plan those are plan if you follows on a certain income level and yes, it is law you can you qualify for some of those plan like Kuumba part of that Medicare beneficiaries and there are some great benefits for individuals.

So if a person thinks they qualify those plans, give us a call.

We'll look at our monthly income and also assess and if it falls in that, you know, they may become a member of Kuumba and Kuumba offer a lot.

They have many individuals with Kuumba.

They don't have to pay anything .

They get most of their medicine free and some get this card for they can purchase other things besides medicine.

They can go to grocery store.

They can pay a lot out of you know, get a lot of items that they probably wouldn't be able to get because their income wouldn't allow them right.

So for individuals just because you're not on Medicaid does doesn't say you don't qualify for other benefits.

The government has done a great job trying to help everyone with low income because even though we see people we don't know the income but they have to let us know then we provide this necessary service so they can get qualify.

>> I was thinking of a a point that you had raised Paul earlier to building on what art is saying that sometimes the question comes up am I allowed to use a drug discount program instead of my Medicare Part D plan and the answer turned out to be yes, yes.

>> Know you you have that option of deciding which card in effect to give to the pharmacist at the time and sometimes I in my own personal experience a drug discount plan is less expensive than the drug plan that I have.

So it's it's it's having that option is a good opportunity to save money.

>> Yeah.

We had another question that had come in before our show here which said that if a person chooses a Medicare supplement plan, can this individual enroll in a Medicare Advantage plan and keep the supplement?

>> No.

Once you if you have a supplement then you decide on open enrollment.

You want to go to a Medicare Advantage plan, you're going to lose that supplement.

OK, You cannot have both.

You either got to have original Medicare with to supplement Medicare Advantage plan.

to to kind of get to a of year- summation sort of question if someone feels comfortable and that may be the key thing they feel comfortable with what they have right now, why would someone wish to change their coverage and use this period to jar their feelings of comfort based on what they already are?

>> Yeah, that's that's a good question.

And some people do fall into that trap of just saying well I made that decision last year.

It's going to be good for a while and there have been changes to the Medicare plans.

I don't know how that person's their particular drugs for example, how they will be priced next year or if their drug plan will even cover all of their medications that they take.

So that's a consideration that the individual have to give do is everything covered as well as that going through that same Medicare Advantage checklist you can go through that checklist almost for for even if you're not on an advantage plan you can look at that as is a way to make sure that you're covered so that I guess I could liken it to buying a homeowner's insurance and making sure that your house is covered .

>> Yes.

Just in case that's anything you want to end on that one.

>> Well, you know, we encourage everyone don't change just to be changing.

Oftentimes a person might be talking to a friend and they may have a way to explain to you that plan is better than mine but don't just jump on a plan and change because someone else gave you some it's OK because you may be so but the key you don't have to make a change if you are satisfied with your plan you don't have to do anything.

Some people have been on the same plan for , you know, two or three years, four years.

You know, it's not mandatory that you have to change if you satisfy if it ain't broke, don't try to fix this right.

>> On the other hand, you don't know how long the smoke detector battery has been up there and sometimes it's good to check.

Yeah, it's good to just put the new one in every fall.

It's good to review your information regarding Medicare coverage about this time of year as well.

Here is how you can find more information about where the state Health Insurance Assistance Program counselor is closest to you.

There is the phone number three seven three seven nine five two and of course a website to go with that Fort Wayne ship dot com.

Gentlemen, welcome to your fifth season of the year summer, fall, winter, spring and Medicare indeed you've done it for a long time.

Best of luck for the weeks ahead.

Thank thank you so much for being very generous.

Thank you.

Paul Thierer of art and Ship Counselors here to assist you in the coming days and for all of us with prime time, I'm Bruce Haines.

Thank you for allowing us to be a part of this day with you and we'll see you again next week.

Thank