The Generations Legal Group Podcast
“Aging” or “Growing Old” has to be better than dying young, right?? Join Certified Elder Law Attorney, Todd Whatley, Founder of Generations Legal Group as he dives deep into the complexities, sensitive topics, and how-to’s of becoming an “aging individual” or caregiver of an aging loved one. This podcast covers senior-related caregiving issues, legal/financial issues, when to stop driving, late in life marriages, grief, death, and other end of life concerns. If you struggle with what to do next, how to cope, or simply the basics on what lies ahead as you or your loved one ages, this podcast provides solutions to your questions.
The Generations Legal Group Podcast
Navigating Medicare Changes: Expert Insights and Strategies for 2025
Unlock the critical insights into Medicare changes with our expert guest, Paul Livingston, a seasoned registered nurse turned Medicare advisor. Gain the knowledge you need to confidently navigate Medicare plans and avoid the pitfalls of misinformation. Understand the pivotal role of independent brokers in tailoring healthcare options to your specific needs, especially when considering the region-specific nature of Medicare Advantage plans and the impact of individual prescription requirements. For seniors living on limited incomes, staying informed about major Medicare changes is crucial. Paul offers guidance on strategies to manage these shifts effectively and ensure your health and financial well-being are prioritized.
Discover the practical routes available for handling medication costs without the stress of overwhelming initial payments. We explore federal programs that spread expenses throughout the year, making healthcare more manageable. Learn about the flexibility offered during the trial look period when transitioning between traditional Medicare with a Medigap plan and Medicare Advantage. However, understand the challenges that arise when attempting to revert back to a Medicare supplement, particularly for those managing chronic health conditions. This episode promises to equip you with the tools to make informed decisions regarding your Medicare options, empowering you to navigate this complex landscape with greater confidence.
Call Paul Livingston at 479-347-9920
Information to help you answer all of your questions about aging.
Welcome to Answers on Aging, the podcast dedicated to helping you navigate the complexities of growing older. Your host is Todd Whatley, a certified elder law attorney with a passion for empowering the aging community and their families, From finances and legal matters to health, long-term care and beyond. We've got you covered, Because every question you have we aim to answer. Dive into today's episode and let's uncover the truth about aging together.
Speaker 2:That's right. This is the Generations Legal Group podcast and my name's Todd Whatley and I'm so glad, as always, that you have listened. And again today I have a guest. It's not just me sitting here going on and on and on about stuff. I actually have a guest and we are recording this the beginning of November, so it is open enrollment for Medicare time and I have my favorite Medicare guy here. His name is Paul Livingston. Hey, paul, how are you?
Speaker 3:Hey, todd, nice to be here. Thanks for having me, I appreciate it.
Speaker 2:Well, I know you're busy, your phone's ringing off the hook, I'm sure. Well, I know you're busy, your phone's ringing off the hook, I'm sure. But I appreciate you coming in to give our listeners some of the latest news on Medicare. Okay, so, introduce yourself a little bit, give our listeners a little bit of background and then let's just jump into it. Okay, cool.
Speaker 3:Well, yeah, I really appreciate, Todd, having me on my name's Paul Livingston. I am professionally a registered nurse by profession, spent 40 years in health care, and so in 2017, you know decided to choose another career kind of my last career and so I always wanted to be in a position where I could help people understand Medicare benefits. We saw so many people come into our facilities that they didn't understand how their Medicare worked. Their kids didn't understand how their Medicare worked, and it was already stressful enough and that made it more stressful. So I guess, one by one, I'm trying to help them out, and so Medicare is confusing and just another little antidote there.
Speaker 3:I mean, you know, healthcare professionals are not trained in Medicare. They're not trained to understand how Medicare original Medicare works with Medicare supplements, or how drug plans work or how Medicare Advantage works. That's not in their purview. They don't get trained on it. We never had a course in all of my years on anything to do with health insurance. So you do have to be a little cautious about where you get your information. You have to be cautious of getting it from family and friends, and so your best source is to try to find an independent broker, a health insurance agent who does Medicare and does it all. Does Medicare Advantage, does Medicare supplements, prescription drug plans. That's going to be your best bet, so you'll feel comfortable walking out with the information you need to make a good decision.
Speaker 2:Yeah, I'm on Facebook and I always threaten about getting off of it because there's so much misinformation. But I think one thing that drives me crazy is someone will just they're not asking the right people, they're just throwing it out there. Hey, should I get on blank Medicare? And the response is you know, you should never say never. And people are like, oh, never, do this or never. And I'm just, oh my goodness, people and I'll normally chime in and say, look people, your Medicare plan is very much tailored to you and you need to go see a professional who can look at your situation and plug it into the system and figure out what is best for you. Please stop taking advice from your next door neighbors or God forbid people on Facebook.
Speaker 3:Yeah, really, and that's great advice. I mean I could just go on and on about conversations where I get calls even from my clients going. Well, I talked to my sister. She's in California, I'm here in Arkansas. She told me to get on this. I mean you really just can't do it. I mean these plans are really designed by actually region or zip code. They're designed by actually region or zip code.
Speaker 3:So in everything, everything is driven by your prescription medicines. I mean that's the place that that's something that's going to happen for you every month. Those costs. Some of our folks are on very few medicines or no medicines and some people are. I just walked out of an appointment where a lady was on three tier three and four drugs and those are expensive and trying to find something for her that's affordable with somebody that has limited income because she's just living on her Social Security and it was roughly about $1,750 a month and many people in the country can kind of resonate. That kind of resonates with a lot of people at 65 years and older. So I tell people when they walk in to visit they're going.
Speaker 3:You know, as you're explaining this stuff, paul, this Medicare Advantage stuff, it sounds too good to be true. Why is it like this? And I said well, really it is. Medicare Advantage is structured like an employer group plan, but it's about a thousand times better. And it is built for people who have turned 65, because there's only 19 percent of our folks who are 65 years and older that are still working part time or full time, and then you know. So that leaves everybody else out there, maybe just trying to make it on their Social Security.
Speaker 2:Yeah, it is so hard, and so talk about some of the changes that are coming. You know it changes every year some, but it seems like this year there's some major changes and I want our people to understand this some major changes and I want our people to understand this.
Speaker 3:So, um, it doesn't really make any difference whether you're on medicare or on original medicare with your red, white, blue medicare card and a medicare supplement and a standalone prescription drug plan, or you're actually on medicare part c, which is medicare advantage, and your drug plan is built into your Medicare Advantage plan. Doesn't make any difference which one of those prescription drug plans you're on. In the middle of the year, the federal government basically said hey, all of our Medicare members, this is what we're going to do for you. We do not want you to have to spend more than $2,000 out of pocket for your medications in 2025. And that sounds just wonderful and it is wonderful and it really is going to help a lot of people who are on multiple medications, eight plus drugs or expensive medicines, and so that's going to be wonderful.
Speaker 3:So the other part of that story is the donut hole is gone. So we have it this year in 24, but in 25, the federal government removed that whole donut hole thing. And so when an individual you know, when that prescription drug impact for an individual hits $2,000, then it's going to go into catastrophic coverage. When it goes into catastrophic coverage. Then the prescription medicines cost zero, so there are a lot of people that this benefits. So when they did that, that's wonderful. But they shifted the burden of cost away from the member and the insurance company to just more towards the insurance company, so other things got affected. In the plans going into 2025.
Speaker 2:So a company can't just absorb that and say, oh well no, there's only so much money out there.
Speaker 3:Yeah, I was just sharing with Todd. So if you were a person that took any type of chemistry class in high school, the first rule was for every action there's an equal and opposite reaction. Well, the opposite reaction in this scenario is that the insurance companies, like the United Health Cares and Blue Crosses and Humana's and Aetna's and WellCare's and Cigna's and on and on and on, they had to adapt. They can't handle that cost burden. So what happened was they kind of had to not give the member as much benefit when they were waiving the prescription drug deductible, which is $590 for the year. So in years past they would let certain tier level drugs not be applied towards the deductible. So that kind of got reshuffled a little bit. So there's going to be more people that are going to have to eat this deductible and so their january, when they go to their pharmacy in january, their medication costs could look a little bit different than what it has in years past.
Speaker 3:And then um, specifically on the Medicare Part C or Medicare Advantage plans, we, as agents that are appointed with all these carriers out there, we have watched over the past few years all of these co-pays get lower and lower and some of these extra benefits like dental and vision and hearing aids and food cards go up and up and up.
Speaker 3:Well, that's going to drastically change in 2025 because now our co-pays are going to go up and up and up. Well, that's going to drastically change in 2025, because now our co-pays are going to go up and all of our extra benefits in general those are going to decrease, and so a lot of members are going to get in and look at their plans in 2025 and go whoops, this looks a little different Now. Members get these annual notices of change mailed to them by the carriers every year, so they're getting this information ahead of time. But of course, you have to look at your annual notice of change document. That comes in the mail and a lot of people do, and I've had a lot of meetings already because, todd mentioned, we are in annual enrollment now between October 15th and December the 7th, so it has been a very hectic and busy time.
Speaker 2:Sure, well, and I've told people every year and I'm not sure they listen, but it's like every year, even though you love your plan, this plan was fantastic this year, so I don't have to make a change. No, that is not true, and particularly this year. You have to go in every single year and talk to your agent and figure out what is best for you next year. Just because your plan was good for you last year does not, does not, does not mean it's going to be good for you next year, and that's particularly the case this year. So I'm telling you, as a non-insurance person, is you've got to go talk to someone and look at your situation. So what does someone need to bring into you in this meeting for you to be able to tell them what they need to do?
Speaker 3:Well, of course, when we're reaching out or even talking to somebody that's potentially a new client, we're usually asking the first question is so can you give us a list of your medications? I mean, yeah, we need to look at those meds and kind of get an idea, because those medicines are going to kind of drive us to the right prescription drug plan the freestanding prescription drug plan or they're going to drive us to the right Medicare Advantage plan, and so that's the place to start and just to start having that conversation, and then we just kind of back in once we can kind of see where this is going. We do a lot of education on trying to make sure that somebody understands their benefits. What does you know? How are they covered with Original Medicare, if that's their choice. How are they covered with Medicare Advantage and how you know if that's what their choice has been and be able to help them just hopefully simplify their choices going forward.
Speaker 3:And it can very well mean that they're fine where they're at and you want to talk to an agent that is that kind of person to be honest with you. That agent is not coming in just to enroll you, because that's how agents get paid. I mean that is not really my slant. I mean I'm here to provide your information and I may be sitting there going well, I mean you're not my client and you got enrolled through a telemarketer, but that's all well and good. But honestly, based on your medicines and based on what your needs are, you're fine and I may walk out of there and that's just part of it.
Speaker 3:And people are very sensitive. They go well, we need to pay you for something. I mean your time. I said, well, do you pay your auto and home agent when you call three of them and you get a quote? Yeah, no, well it's. It's really no different. I mean. So I'm here and I said, if you are comfortable with how I explain this to you, you're going to share my contact information with a family member or a friend and say, you know, you might want to talk to Paul because he's not. He's not there to sell you something. This is not a sell. This is because it's going to work out one way or the other. So I want you to feel very, very comfortable with that.
Speaker 3:Now let me go, before I forget this, one of the other aspects and I mentioned it before that people may get very surprised with their drug plans at the beginning of 2025. In other words, you may walk into your pharmacy in January and go. They say, well, you know, this is what it's going to cost you in 2025. And you're going to say, well, that's not what it cost me in 2024. But it's not 2024 anymore. That little ship has sailed. So 2025 is going to look different.
Speaker 3:And if it looks like that you know it's a few hundred dollars to get your medicines in January the insurance companies have to set up a payment program for you to spread that upfront cost over the year. If that's what you want to do and you would deal with the Blue Cross and Blue Shields, the UnitedHealthcare, the Humana and whoever you're working with WellCare, and you would call them and say, hey, look, I want to set up this MP3 or this payment program. They'll know exactly what you're talking about, they'll set it up and you'll pay out your medicines over the course of a year, versus paying this big bolus or just big amount at the front two or three months of the year, so that $2,000 they have to pay can be spread out over the year.
Speaker 3:Yeah, and it's not going to look quite like that. It's not going to be like 2000. It's going to be like you're going to, but what's going to happen is you're you know, like I mentioned earlier, maybe some of your medicines are not going to be waived, your tier levels of those medicines are not going to be waived, and you're going to have to eat off a chunk of that $590 deductible. In other words, one of your meds is going to apply towards the deductible before it goes into that co-pay phase, and so when it does that, you're going to go. Oh my God, that's $300 for my meds. I never paid that much, and then the next two months could look a little hokey also. So it just really depends. And so, bud, don't get super panicked. Just know that you have an avenue to go directly to the carrier and ask to get on a payment program. Just spread that out over the 12-month period. And so take a breath, Because I know it's going to be scary, but it will work out in the end.
Speaker 2:That was nice of them.
Speaker 3:Yeah yeah. Well, that wasn't really so much nice of the insurance companies. That was the other piece of the mandate from the federal government. Ah, Okay. And now they have to manage a payment plan where they really weren't thinking about that either. That was nice of the government to make them do that it was nice of the government to make them do it. It was nice of the government to make them do it.
Speaker 2:That's exactly right. Wow, okay. So okay, that's very interesting, remind me, and I never can keep. There's a few things in my life I just cannot keep straight because I know the right people to ask One of the Medicare plans traditional Medicare, if we call it that and Advantage plans, one of those. You can go from one to the other, but you can't go from the other to the other. Remind me of that.
Speaker 3:Okay, so the basic rule. Here's the cleanest part of this particular rule that Todd's talking about. It's really called a trial look period. But let me just try to explain this. People who choose to use their red, white and blue Medicare card as their primary health care card, that group may choose to buy a Medicare supplement slash Medigap plan synonymous terminology and they will have a premium with that. And that Medigap plan functions because it takes. It will cover, for the most part, the 20% co-insurance that your red, white and blue Medicare card does not cover. And so you're paying this premium.
Speaker 3:And you may say well, I would kind of like to maybe think about going over and testing the waters on the Medicare Part C, over Medicare Advantage World. As a matter of fact, can I do that and go back? Well, what you can do is that if you start out on a Medicare supplement, you can go to Medicare Advantage at any time, and that's called a trial look. And so you can go to Medicare Advantage. You would cancel your Medigap plan and you would live in Medicare Advantage world as long as you, for you know, for a while, and if you didn't like Medicare Advantage world, you could then, within a 12 month period of starting your Medicare Advantage plan, you could go back to your Medicare supplement plan what we call guaranteed issue, not asking health care questions. They have to give it back to you and what the premium is from the company you came from, okay, and then you can continue to rock along there on that pathway and at some point in time maybe the premium gets too high.
Speaker 3:You're going. Well, I'm going to go back to Medicare Advantage. Once you go back to Medicare Advantage then you can always reapply for a Medicare supplement, but you're going to go through underwriting with it and if you have a health condition, a chronic health condition, you're not going to get approved. So there's a fairly decent chance. Now the other part of this rule is if a person is new to Medicare in their initial enrollment period and they start on Medicare Advantage, they can stay on that Medicare Advantage plan for the first 12 months, and now they go.
Speaker 3:I don't like this. They can go to a Medicare supplement Medigap plan at Guaranteed Issue one time. They can stay in that world, walk, you know, kind of amble along for as long as they want to, and then if they decide to go back to Medicare Advantage, they can, but then after that, if they want to go back to Medicare supplements, medigap plans, they're going to have to go through underwriting. So there's kind of two little pathways there, and so it does sound complex and it is kind of hard to keep straight sometimes.
Speaker 2:So there is no underwriting if you go to traditional Medicare at your 60 field.
Speaker 3:That's right. No underwriting. You're guaranteed accepted Guaranteed issue.
Speaker 2:But if you go to Advantage and then try to go back, if after a year or your second attempt there's underwriting, and the chances are you're not getting it.
Speaker 3:Yeah, you have to. I mean and that gets down to the company you're trying to get your plan through Some companies are pretty strict with underwriting, others are a little bit more lenient. But most of the time if you're pretty healthy, know you don't have any chronic conditions like respiratory diabetes, kidney disease, heart disease, and your medications kind of dictate that If you're on a little bit of a thyroid medicine, a blood pressure medicine, a statin, an anxiety medicine, things like that, and you don't have any of these chronic things in your medical record, yeah you could probably get through underwriting and get a plan. But there is no underwriting for Medicare Advantage, part C or Medicare Advantage. There is no underwriting there. That's all guaranteed issue back and forth they will take you, they'll take you. They won't drop you, they'll take you. Yeah, okay, interesting. Okay, all right, they'll take it.
Speaker 2:They won't drop you, they'll take it Interesting, alright. Is there anything we didn't cover that you really want the folks to know?
Speaker 3:The other thing you're going to see. If you're on a Medicare Advantage plan and just as a tip, you're looking at you see TV advertising or you get stuff in the mail and it says, hey, if you get Medicare Part C you're eligible for more benefits. If you're on a Medicare Advantage plan, you already have Part C. So don't fall for that little bait and switch. I mean, that's just a little trick to get you to call in and then the next thing they're doing is getting you to say yes and you've signed up for something and you don't even know what you signed up for.
Speaker 3:I think that what you're going to see with your Medicare Advantage plans across the board, there are no just big boppers out there that somebody's just loaded up with a lot of dental, a lot of food cards, a lot of low co-pays. I mean there's a lot of parity out there. So really getting the right plan is really driven by your prescription medicine. So there's no big shining stars out there on the Medicare Advantage plan. That's just my opinion. Other agents may have a different opinion, but there are some values out there. But you have to look close.
Speaker 2:And please, for the love of God, don't call the 1-800 number on the TV.
Speaker 3:Yeah, don't do that. I mean you're talking to, it's not telling who you're talking to.
Speaker 2:Well, and you're going to get 5,000 phone calls from all these. That company sells your information to agents and these agents.
Speaker 3:That's right.
Speaker 2:Call Paul, okay, what's your phone number?
Speaker 3:My number is 479-347-9920. And just if I don't answer, just leave me a message. I'll get back with you.
Speaker 2:That number will be in the show notes so you can just scroll down and find his number. So yeah, best advice ever Don't call the number on TV that Fonzie or whoever is trying to get you to call. Okay, call Paul, he will call you back. He will go through this stuff with you and you don't pay extra. That's something else, people. You don't pay extra. The company pays Paul to do this for you. You do not pay extra. If you call the 1-800 number or call Paul, it's the same price.
Speaker 3:Yeah, all right, man. Thank you so much. Hey, thanks for having me.
Speaker 2:It's always so much fun and I think being a nurse like me being a PT in the past kind of brings additional knowledge and I appreciate what you do and thank you listeners for listening and we will see you next time.
Speaker 1:And that's a wrap for today's episode of Answers on Aging. Thank you for joining us on this journey of discovery and understanding. For more resources, detailed show notes and expert advice on the many facets of aging, don't forget to visit our website at wwwanswersonagingpodcastcom. Remember, growing older might be inevitable, but doing it with grace, knowledge and empowerment is a choice. Until next time, stay informed and keep those questions coming.