The Angry Biller
Welcome to the angry biller.
A show where we explore the people and the businesses behind-the-scenes of healthcare, those men and women that are the catalysts that allow providers to concentrate on delivering exceptional patient care.
The Angry Biller
Ep 21 - Healthcare Insights: Jill Santos on Medicare and ACA
Unlock the secrets to navigating the Medicare open enrollment process with our esteemed guest, Jill Santos from All About Medicare. Jill brings her extensive knowledge to the table, guiding us through key dates, the vital importance of guaranteed issue plans, and how these options are a lifeline for those without employer group coverage. You'll gain insights into how subsidies are determined, the role of agent consent forms, and hear a touching, real-world example of how Jill helped a new resident find the right healthcare solution.
In the second half of our conversation, we tackle the Affordable Care Act (ACA) application process and the intricacies of the 1095-A form. Discover how having a dependent impacts your premiums and tax credits, and why it's crucial to keep your income information up-to-date to avoid IRS discrepancies. Jill walks us through common scenarios like changes in household income and dependents, offering practical advice to ensure you receive the correct subsidies. This episode is packed with essential information to help you make informed decisions and navigate the complexities of health insurance with confidence.
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Production of Podcast: VISUALS BY MOMO
Josh Fertel
00:04
Welcome to the Angry Biller, a show where we explore the people and the businesses behind the scenes of healthcare, those men and women that are the catalysts that allow providers to concentrate on delivering exceptional patient care. Welcome to the Angry Biller. My name is Josh Fertel. I am the founder and CEO of J3 Medical Billing. We are here at the Visuals by Momo studio and we have a repeat guest.
Jill Santos
00:27
Hello.
Josh Fertel
00:28
Jill Santos from All About Medicare, and the reason we asked Jill to come back is because we are coming up on open enrollment for Medicare and I want her to come in and explain who it is that needs help, how she can help and hopefully do the right thing for the people out there. How are you doing, jill, good?
Jill Santos
00:47
seeing you again, all right. Well, thank you for having me and thank you for the great introduction.
Josh Fertel
00:51
Thank you, thank you, of course, of course.
Jill Santos
00:54
We're getting ready. Open enrollment's just right around the corner. So thank you for having me, and I'd like to spend a little bit of time to let everybody know what to expect this year what I'm hearing, what I'm not hearing.
Josh Fertel
01:07
So, before we do that, though, give us an update on what's been happening in your world since last we spoke.
Jill Santos
01:14
Oh well, right now. What's happening right now is everybody is gearing up for the new open enrollment.
Josh Fertel
01:20
So we have a Medicare.
Jill Santos
01:21
Open enrollment starting October 15th through December 7th. And we have the marketplace plans. Those are Affordable Care Act plans. We now call them ACAs to be politically correct. Their open enrollment is going to be I believe that was going to start November 1st through January 25th of 2025.
01:38
So November 1st for the marketplace plans, correct so they extended it an extra three weeks, I believe three, four weeks, so it's a little bit longer this time. Correct, so they extended it an extra three weeks, I believe three, four weeks, so it's a little bit longer this time. Okay, so, yeah, all right.
Josh Fertel
01:47
So give us some details. Okay, let's start with who qualifies and what they need to do.
Jill Santos
01:55
So these plans are guaranteed issue number one. So that's the first thing. So they're not underwritten, they're guaranteed issue, which means all preexisting conditions, whether if you have this or that, they're all accepted. No health questions asked None. It's been that way since day one. Okay, there's also. Everybody thinks there's a penalty. There's no penalty, Hasn't been one in about four years. Five years.
02:19
I know there used to be a penalty, yeah, so that was gone, thank goodness, and you know, the people that we are looking for to help are the ones that are actively working, that have employers that really don't offer them employer group coverage.
Josh Fertel
02:34
OK.
Jill Santos
02:35
OK, that would be an ideal person that would normally be looking for something other than employer group coverage, gotcha. Then we have folks that are self-employed. Okay, you know they work as a 1099.
Josh Fertel
02:48
Okay.
Jill Santos
02:49
They too, depending on how much their income, net income is, would determine, you know, what kind of pricing they're going to get on premiums, which leads us to the next Okay, so the premiums are really. You know, aca is very complicated. There's a lot of moving parts. Even when I started as an agent in 2013, the first year it rolled out, it was very difficult to understand that discount. You were getting that subsidy. They call it the annual premium tax credit. So this whole discount is based off your tax returns and the size of your household. Gotcha Like are you a married couple with children? Are you head of household with one child?
Josh Fertel
03:30
Okay.
Jill Santos
03:30
Right. So it really all depends on meaning price-wise is how you file your tax returns, okay. So, according to whether if you're single or married, you're going to get totally different subsidies and, of course, married folks apply together. Okay. Now, I'm not what you call a tax advisor, right, but when you have a married couple per se and they've got some other entities like a side business, that's important to maybe reach out to a tax person that can have you tally up your actual income, your net income, okay. So, without making it too complicated, which it sounds already, that it is.
04:13
I try to have fun with it and I try to basically explain it in layman's terms. So, I had a lady that called me last week. She just moved into town from New York. She had, I believe she had a employer group coverage. Never heard of it. So she's now here in Florida, has been here now for about 50 something days, so over the weekend I had signed her up. She says when does my plan start? I said start September 1st. Wow, really, I'm like yeah're, you're at the end of the month right you know you're you.
04:48
You have a 60-day window if you lose coverage. That's all they give you, and you're right at the end. So you're going. Your coverage is literally going to start next week. Um, so it's really not a cookie cutter scenario for every person that I speak to.
Josh Fertel
05:05
But let's continue with this one person, okay.
Jill Santos
05:07
So when we signed her up, she said I am separated.
Josh Fertel
05:14
Okay.
Jill Santos
05:15
But this year my husband's claiming my daughter.
Josh Fertel
05:19
Okay.
Jill Santos
05:19
When that kind of conversation comes up, it's usually I just simply ask the questions of the application in here, and I'm going to back up a little bit because something has changed for the better to protect our clients and to protect the agents, and that is consent forms. The first thing we do before we even talk about anything whether if it's a new client or someone that's trying to update their information is now they have to consent to an agent consent form, an agent of record form, before there's any discussion on any plans or pricing or even any search lookups, before we do anything. Um, our government cms is requiring everyone, every agent, to make sure those consent forms are signed, and the reason being it's because they're trying to regulate the plans. They're not quite regulated, but they are closing certain things because of the abuse that we've seen over the last 10 years with people losing their business to other people that they don't know, for example.
Josh Fertel
06:22
I get it Okay.
Jill Santos
06:23
So there's a lot of new guidelines coming up, but nothing we can't handle. We just simply explain to the client these are new forms and they can revoke the agent anytime they want. That's their choice. Once they sign that, then we can start looking. Once they decide to pick a plan, then they sign another form to allow me to do that enrollment.
06:44
So it's quite lengthy. There are some streamlining tools I can use to kind of expedite that a little quicker, but the enrollment towards the end might be a little bit slower than usual because of all the hoops now that we have to sign off on.
Josh Fertel
07:00
Okay, so let me ask a question. Then we're going to go back. So if it's a lengthy process, does somebody have to wait till November 1st to start the process, or can they start the process before and then submit? Excellent?
Jill Santos
07:10
question. I'm so glad you asked that this year we will be contacting our agents to get them to sign the new consent forms prior to the open enrollment. The agents, the clients excuse me that we already have established. Right so they're all have received consent forms and they are very well aware of that. But yeah, that's a really good question. Let me process that. Ask me that question one more time, please.
Josh Fertel
07:37
If open enrollment starts November 1st and between the consent forms and all the forms that need to be signed, can those be signed prior to November 1st to get the process started?
Jill Santos
07:48
And yes, that is correct, yes and no. The first consent form to be the agent of record is a yes.
Josh Fertel
07:52
Yes.
Jill Santos
07:54
We can do all the quoting they want if they're my current clients prior to open enrollment, as long as the new rates are out Correct Right, which they usually come out about a week before November 1st, correct Right, which they usually come out about a week before November 1st. And if they decide on a plan, then we can definitely enrollment. They do have to sign on the ascitation form to allow me to enroll them in that form. Now it can be done in a lickety split. Everybody has an iPhone or an Android. They can look at their email and sign it right off of their iPhone.
Josh Fertel
08:19
Okay, that's great.
Jill Santos
08:19
So we hope it's going to be. It might be a few bumps in the road at first, but this is a new process, probably take maybe three minutes at the most to sign and submit. And you know, bless me as their agent. Oh that's good, okay.
Josh Fertel
08:31
So let's go back to your client now. Her, her ex-husband is claiming the child.
Jill Santos
08:36
So every year I have a couple of clients that go back and forth on claiming their child. Okay, so I ask the question, they give me the answer. I put it on the application At the end of the year. If they have data matching information that will be settled through their tax people and the forms that they get from the marketplace, that form must be attached. It's called the 1095A form. It shows how the application was set up, how much of a subsidy they got every month and how long they had that coverage for.
09:10
So, answering your question. It can be a little technical to answer that question because I don't give tax advice, but when I ask the question these answers are supposed to be in good faith, which most of the time they are. It's usually something that they deal with at the end, going into the new tax season in regards to all that red tape, but it should match the application. So if this year she's saying husband's claiming daughter and I set up the application that way, but the following tax season she said dad was claiming Right.
09:42
But somewhere along dad and mom changed their mind on the mom's claiming she could actually get more income tax back because she was getting subsidy as a single parent. Gotcha, not with the dependent. You still get that child credit on the ACA form right on the insurance.
Josh Fertel
09:57
I mean on the application with the market so so having the child affects the premium absolutely.
Jill Santos
10:03
Absolutely it does? Absolutely it does, because you get child tax credit on that and if you're claiming one dependent as a 25-year-old, let's say, you'll get a $600, $700 deductible with one child.
Josh Fertel
10:18
Gotcha.
Jill Santos
10:19
If you're filing solo no dependents, then you're probably looking more like half that.
Josh Fertel
10:24
Okay, so it's a big difference when you're putting a child on the application, right.
Jill Santos
10:29
But what if they want to go on Medicaid? Or what if dad has the child on his group insurance?
Josh Fertel
10:35
Right.
Jill Santos
10:37
It's all about how they file taxes.
Josh Fertel
10:39
Gotcha.
Jill Santos
10:40
It's not about if daughter's on right, so daughter could be on dad's plan.
Josh Fertel
10:44
Okay.
Jill Santos
10:44
Under the household income right Mom claiming right. And only mom enrolling but daughter's on dad's plan, it gets complicated.
Josh Fertel
10:54
Okay, so let me ask you this question.
Jill Santos
10:55
I'm pretty versed on it. I've got a really good feeling for this after 13 years of writing this kind of business.
Josh Fertel
11:01
So November 1st the plans go into effect supposedly. November 1st the plans go into effect supposedly.
Jill Santos
11:05
November 1st open enrollment begins. Those plans will start January 1st. Okay, great so.
Josh Fertel
11:09
January 1st the plan starts. Taxes are due in April, correct, so are you going off of the previous year's taxes or the upcoming year's taxes?
Jill Santos
11:19
Very good question. It is the previous year taxes, so if you're buying 2024 coverage right now and the next tax season comes around in next April, that's for 2024 tax season. Your coverage is for 2024 tax season, so you're kind of always behind one year. Okay, so what just happened now was 2023 coverage with 2023 income this past.
Josh Fertel
11:43
April Got it, I got it.
Jill Santos
11:44
For April 2025, it'll be 2024 taxes, 2024 income based off of 2024 health coverage. So it's all about the tax season that you're in. Got you Period For the following tax season, so kind of like a year behind. It feels like.
Josh Fertel
12:01
As long as it's consistent. Right All right, I want to take a break here. Okay, when I come?
Jill Santos
12:04
back behind.
Josh Fertel
12:04
It feels like it makes sense, as long as it's consistent, right, all right, I want to take a break here. Okay, when I come back, I want to hear again how this one situation played out.
Jill Santos
12:08
It's complicated. I'll try to simplify. There's so many different scenarios, you'll be able to All right. Thank you very much. We'll be right back.
Josh Fertel
12:13
Okay, bye.
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Jill Santos
12:31
It's complicated, isn't it? It's not like Medicare there's part A, there's part B.
Josh Fertel
12:35
We are.
Jill Santos
12:36
So what I'm going to do is go back and review everything. Let me at least explain how I do the enrollment with a client. Okay, okay.
Josh Fertel
12:44
Again, I think we're on a good path here, talking about this one client and the process that went through her. Right so now you've tackled the tax situation.
Jill Santos
12:53
Right.
Josh Fertel
12:54
What was the next step?
Jill Santos
12:55
The next step is now. We're in April of 2025. Right mom has said I'm dad's claiming daughter okay mom's like I'm the only one that needs the insurance. I make about 30 000 a year okay and my daughter is already he. She doesn't need to be enrolled, she's on dad she's on dad's policy, got it so now let's say a life change happens, right? Let's say something happens and mom decides to claim the child.
Josh Fertel
13:26
Okay.
Jill Santos
13:26
And between the time between January and between the enrollment date and now in April.
Josh Fertel
13:33
Right.
Jill Santos
13:34
Let's say they changed their mind and mom's going to claim instead of the dad.
Josh Fertel
13:37
Okay.
Jill Santos
13:39
And let's also throw something in that she got a promotion. Now she's a supervisor manager.
Josh Fertel
13:44
Okay, so she's making more money and she has a child now, so now she's at $60,000 in management right Got it and she's going to claim Okay.
Jill Santos
13:52
So here's what can happen. It's important to update the income if it's that significant, especially if you have capital gains on selling a house. Sure, Because anything that's taxable. They're going to compare your actual income at the end of the year and compare it to the income on the application Makes sense so what could happen is that if she forgets to report it, which most people do, and you get that 1099A form with all the subsidy on there at the lower income right she might owe some of that back because now she's not making 30, she's making 60 that makes sense.
14:25
So she's gonna owe half of that 400 that she's been getting over the 12 months that she's had the coverage makes sense so if you multiply 12 times, or 200 times 12, that's 2400. Right, you know that she's got to pay back. That's a lot to deal with with the IRS, sure, and most people don't know that. You can put whatever number you want on there, but at the end of the day they do catch up with you I I imagine that, based off that form, the 1095a form.
14:51
Okay, they, those are those forms that must be part of the taxes, otherwise they just reject it. And those, those forms are mailed out at the end of January every year. So, getting back to this lady, she may not see a savings because now her income's higher. That discount's based on the lower income Right. The more she makes, the less discounts she gets. So the rule of thumb is the lower the income, the lower the premium. The higher the income, the higher the premium.
Josh Fertel
15:17
Okay, so let me stop you right there and ask this question what's the income threshold?
Jill Santos
15:26
The income threshold, for I have that in my phone. The income threshold is a chart that the government puts out every year to help qualify people for health insurance.
Josh Fertel
15:34
So let's just say this one person, who's a single person, not claiming her children.
Jill Santos
15:41
She would be about 87% on the dollar. So for every dollar she spends they're covering 87 cents. She's paying the rest.
Josh Fertel
15:47
Based on her 30,000.
Jill Santos
15:48
Based on her based on her, I would probably say based on 30,000. Now, at 60,000, she's probably not getting that much, so she's probably, like I said, if it's double the income, it's double the premium.
Josh Fertel
16:05
Understood.
Jill Santos
16:05
That kind of makes sense, but is there an upper range?
Josh Fertel
16:09
of income. Yeah, there's a threshold.
Jill Santos
16:12
So for a family of two, the way she has the application set up, she would probably go over the threshold. Right 250% and above. Right now it's 300% under the American Rescue. Plan 300% of what 300% of the poverty level, meaning that they make too much income. They won't get a subsidy.
Josh Fertel
16:31
What is that dollar?
Jill Santos
16:32
amount For a single person. Family of two, it could be 80. I'm just giving you a roundabout. I can look it up and I give you more accurate information that's okay.
Josh Fertel
16:41
That's okay, you're giving good information that is public.
Jill Santos
16:45
That is public information. They can look it up under google right for the state of Florida, because every state is different makes sense.
Josh Fertel
16:51
It makes sense, um, so somebody who's up at 60 000 or 80 000, they can still get coverage correct, but but they're going to pay, let's just say, full price they might. Is that fair?
Jill Santos
17:02
Right. The number one factor of premium, though, is always going to be age.
Josh Fertel
17:07
Okay, that is a great factor.
Jill Santos
17:09
So the younger they are, the lot less they're paying.
Josh Fertel
17:12
A 21-year-old is probably about $235 a month with no subsidy.
Jill Santos
17:14
A 21-year-old is probably about $235 a month with no subsidy. Okay, a 60-year-old is probably $600, $650 a month with no subsidy.
Josh Fertel
17:24
That makes sense.
Jill Santos
17:25
They can both get guaranteed issue.
Josh Fertel
17:26
Right.
Jill Santos
17:27
But no, I make more income than her. Well, you're older, so your risk is higher for more claims.
Josh Fertel
17:33
I think so.
Jill Santos
17:33
So there's a lot of moving parts in determining who gets what and why.
Josh Fertel
17:39
Right.
Jill Santos
17:39
So just because you referred me to somebody and he says, well, I want the same coverage and the same price he has, it doesn't work that way, of course. Do you file your taxes exactly the same way he does? Are you exactly the same age?
Josh Fertel
17:51
Right.
Jill Santos
17:51
Do you live near the hop?
Josh Fertel
17:52
So everybody's paying something different.
Jill Santos
17:54
Yeah, everybody's paying something different. It's never usually a cookie cutter because there's so many different ways people file tax returns. That makes a lot of sense. It's hard to pinpoint, but I've been doing it long enough to kind of eyeball it a little bit.
Josh Fertel
18:07
So let me ask you this then, as far as health insurance so let's say, a female, 25 to 30 years old, who's in the age bracket where she's going to have children, how does that affect?
Jill Santos
18:18
Well, so again, guaranteed issue no premium. Not working, she pays for it. If she's working, we figure out where her subsidy is based on an income and how she files. All these plans have 10 essential benefits, including maternity period.
Josh Fertel
18:34
What are some of the other ones?
Jill Santos
18:36
10 essential benefits. You got doctors. You got inpatient, outpatient. You've got critical care. You've got prescriptions. You've got durable medical equipment. You've got some other features in the plan, depending on the carrier. Sometimes you can get chiropractic care, okay, any kind of cosmetic surgery like bariatric surgery. You know, anything that you want done to make yourself look better is considered, uh, cosmetic, and obviously they don't cover that covered, right? Yeah, I mean, you certainly try, but I really, if it's not in the schedule of benefits it's not going to be on the books, it's not going to be on the plan.
Josh Fertel
19:11
Okay yeah, all right, so let's go back to your uh, your client again.
Jill Santos
19:15
Okay, so so now you've.
Josh Fertel
19:16
You have the, the price, you have the consent, you have her monthly premium. What happened?
Jill Santos
19:22
next Life goes on. So it's October, November, December, January 2025, February 2025, March.
Josh Fertel
19:30
Right.
Jill Santos
19:30
She calls me and says, hey, I didn't get my 1095A from they always do. They always call me Okay, some people get them, some people don't Don't know why. Do they always call me? Okay, some people get them, some people don't Don't know why. So I can at least try to generate one for her, if I see it in my back office.
Josh Fertel
19:44
Okay, Hold on one second. So the 1095-A. What is the purpose of that? You did mention it before. Good question what does she need that for?
Jill Santos
19:51
The 1095-A form shows the annual premium, tax credit or discount or subsidy that she's been getting every month. Based on how we set up the application. Got you Income. Size of household.
Josh Fertel
20:06
Right.
Jill Santos
20:07
This is your discount. It's the base price Less your discount equals your premium.
Josh Fertel
20:12
And that's the information that their tax preparer would need to get her the credit.
Jill Santos
20:18
It is a mandatory form that must be included with your tax returns if you signed up and had health insurance for even one month, gotcha.
Josh Fertel
20:27
Okay, and is there's no way for that person to get that online somewhere through the health insurance company?
Jill Santos
20:34
They can call the IRS, they can pull a form, but no, it's something they really need to keep an eye on A lot of people do misplace it and I think sometimes you know they're, they're, they're not really allowing us much back office. So and it really depends on the case In the past I have been able to pull 1095 forms, but I haven't done many this year. They're being a lot more efficient with getting into the household, so I'm getting less and less calls every year.
Josh Fertel
21:00
Okay, so let's go back. I interrupted you so waiting for 1095. She hasn't got it yet Ring, ding, ding.
Jill Santos
21:07
So she gets a 1095. She goes I need to do taxes. She gets a 1095 form, now she's filing taxes and now she's sitting down with the accountant. Right, he sees the tax form, he does his numbers. It's all computerized now, whatever he does, and he asks the questions Did you have marketplace?
21:27
Yes, were you the only one enrolled? Yes, did you have anybody claim on your tax returns? Yes, is she on the application as a dependent? Yes, application when she signed up, right. And is your income the same or did it change? Well, I think I told her $30,000, but now I make $60,000. Okay, so what could happen, being that she has made higher income but yet it's getting the extra child credit now. It could even out as a wash right where she might have a slight increase on that premium because she's losing tax credit but yet gaining it because of the child now. So maybe her tax credit is $200 that she's losing per month, but her child's 263. So a lot of times she'll get a lower premium than when she first started, based on the higher income but adding a child, because without that child it's a higher premium. You don't get that discount Understood Right.
Josh Fertel
22:20
So when she has that 1095A and she's with her tax preparer and she's making more money than she did the year before, they're not going to change that 1095A right there.
Jill Santos
22:29
And then they can't Right, they tally out.
Josh Fertel
22:31
So that's a bottom line. So the following year? No, that moment Right.
Jill Santos
22:34
This is what you owe or this is what you're getting back? They'll figure it out that moment, Okay so they do figure it out. Yeah, they do figure it out, because she's bringing in her W-2. She's bringing in any kind of pension. She's bringing in any kind of CDs. Whatever she's making is considered taxable Capital interest, interest et cetera. Whatever she sold a house, same thing.
Josh Fertel
22:53
So the amount of credit that's on her tax return may be different than what that 1095A says.
Jill Santos
22:58
That's right. We don't know at the end of the day, because life changes.
Josh Fertel
23:01
Gotcha.
Jill Santos
23:02
So that's why in the application they highly recommend you reach your insurance agent, not your carrier, your insurance agent to update any income changes, any email changes, any personal information, especially addresses, Because a lot of times people don't realize they'll stay in the same plan, hemorrhaging because they started at 60,000 and their premium was affordable. But let's say she lost her job and only the husband's now working. Different scenario Husband's only making 30, but yet she's still paying the old premium and the higher income. That's where she can benefit, especially if they lose income to call and make that adjustment because that premium is going to go down. Okay, so how long does that change? It goes from month to month. So if I change the income the last day of the month, it'll be effective the following date.
Josh Fertel
23:49
It's all depending on the next billing cycle, because remember, the billing cycles already happen at the end of the month, so it'll be 30 days.
Jill Santos
24:03
So you'll see 30, 45 days before you see that extra, that change there, Gotcha, so there's. So it's really important from them for them to change the income, especially if they drop Right, Because we want to give them more subsidy to bring down that premium they were at when they were making that higher income. Remember the rule the more you make, the higher the premium. The less you make, the less the premium you pay.
24:19
And that is an ABC kind of a thing. Everything else is usually like well, what does it cover? What happens if I need to knee replacements? How much am I? So what I can tell you about major medical and how you can define major medical. Very important out there, guys, it's got to have a deductible, a maximum out-of-pocket, a co-insurance and a co-pay. If it doesn't have those four, especially the maximum out-of-pocket, it's not defined as a major medical. So what happens with these components? At $30,000, the single lady with the one dependent, her deductible might be because she's the only one enrolled, remember, yeah, so her deductible might be about maybe $900. Okay, right, yeah, okay. And her out-of-pocket might be $1,100. Okay, and these are real, true, close numbers. Her co-pays will be $5 for a specialist, $10 for I'm sorry, $5 for a primary doctor, $10 for a specialist. And these components deductible, out-of-pocket, co-pay, co-insurance, especially the co-pays they can fluctuate too when your income fluctuates. So guess what happens to the co-pay when your income goes up, it also goes up.
25:27
Yes, guess what happens to the out-of-pocket when the income goes up, it also goes up. It also goes up. And what are the other two components, co-ins, this deductible, right? Okay, and they go up, but they also drop. So it makes perfect sense for anybody that has lost income this year, right, don't be proud. Be realistic and call your insurance agent and tell them I need to update my income because I lost 20 grand this year. I need a lower premium period. Now, if it goes the other way, say he wins like ten thousand dollars on a scratch off and he just happens to forget to tell. He's not going to tell anybody. Yeah, he's not going to tell anybody. Number one he won't tell the agent either. Right, but it's capital gain. That's 35% gift taxes.
Josh Fertel
26:07
Right yeah.
Jill Santos
26:08
He'll get nailed on that if he forgets to mention it. By the way, I won the lottery. I have an extra. You know they will catch up with him because at the end of the day he gets a 1099 on that. It's taxable, so he can't omit that from his taxes. He's got to throw it in there and that's where people can get in trouble. And then it always happens when they sell a house.
Josh Fertel
26:26
Okay, oh yes.
Jill Santos
26:28
All right.
Josh Fertel
26:28
So my biggest takeaway so far is that any change in income you got to reach out to your insurance agent If significant.
Jill Santos
26:36
What's what's significant? Right an extra three grand or more a year is pretty significant. Yeah, yeah, I mean we're talking dollars and they add up to hundreds. So I have people that call me on the penny I'm making blah blah and 53 cents a month. Great, okay, good, yeah, I mean you don't have to be on the penny, they just want a ballpark estimate right it says it right on the application, if they read it.
27:00
So that's the tricky part in this whole thing. How much does it cost? That's a loaded question. It really is. Are you single or married? We have to ask these questions, unfortunately, but once they give us the consent and for their protection, these incoming or outbound calls are recorded for their protection.
27:20
Oh, that's great, yeah, and also for the agent as well. But if they say, oh, you didn't say that, we can always pull the recording and say, well, on this day, at this time, I did say that and she might. Oh, I'm sorry, you're right, I remember now, and a lot of them do that.
Josh Fertel
27:34
Right.
Jill Santos
27:40
So to minimize any inquiries or HICS complaints through health sherpa. That's what they call them, hics. We really have to be very thorough when we're talking to them. Otherwise you're just creating more work for you, and the last thing you want is more work.
Josh Fertel
27:51
No, for sure.
Jill Santos
27:52
But you can batten down the hatch and they'll still really will only grab about 10% of it, because they just want to know one thing Does it cover this? What am I? What am I? What's going to happen if I have brain surgery? Well, what's your out of pocket?
Josh Fertel
28:07
It's only $1,100.
Jill Santos
28:09
That's the deal that I'm out of pocket means that's the most you ever pay one calendar year, regardless of how much your healthcare bill is, as long as you're in an in-network hospital and or facility, whether if it's in or outpatient. Now, every once in a great while, there's always that gunslinger that comes from out of state, usually the anesthesiologist that are out of network and in some cases they do get balanced billing on that. That does not go towards the out-of-pocket Bal Balance billing, meaning that's your share.
Josh Fertel
28:39
Right, I get it.
Jill Santos
28:40
So the co-insurance on most of these plans are usually 70% 30%, and the reason I say that that's where the cost sharing plans end up. About 85% of my folks are on silver plans because that's where their income is. It's all about the income on that threshold, that income threshold. So most of my clients are mid to low income. I have a few about one or 2% that are off the chart. So just to give you an idea of the trade, I have a corporate attorney, I have a doctor, I have a chiropractor, I have a public adjuster that owns multiple public adjuster facilities in Broward County, right, so I do have some higher income folks and you know they're happy for the most part. They do have a stop-loss but it's at their level of income that they can handle.
29:30
They're not gonna have an $1,100 stop-loss or maximum out-of-pocket, right, you know, because he makes over 150 $150,000 a year, he's going to have the maximum. You know what the maximum is.
Josh Fertel
29:40
I do not.
Jill Santos
29:41
Like $12,000, $15,000 for an out of pocket.
Josh Fertel
29:45
I get it yeah.
Jill Santos
29:47
But still, that's still-.
Josh Fertel
29:48
For brain surgery. It's still a good deal.
Jill Santos
29:49
It's still a good deal Right. You know it's not going to make or break him, but he's got to pay because that's where income is out, unfortunately, and tell me.
29:56
Let me tell you, people are not happy, right, but I uh, as soon as that penalty went away, I started hearing less and less and less and less. Like this is the law of the land. I don't make the rules, but I can make it as enjoyable as possible. You know, and uh, some of the questions are hilarious, some of the new questions, but you know, we try to break the ice and make it not so serious and not so complicated. I give too much information, I know that. But if people ask me, I know the information and for the most part. But I will never give tax advice, can't do that.
Josh Fertel
30:26
No, you can't do that.
Jill Santos
30:27
Can't do that. I'm not a tax advisor, but we do have great accountants in our chapter so that we can always refer to so Awesome. We can always refer to so awesome, anyway. So that's that's what I got to say. So if I didn't explain it in a very simple term, it's because it's very difficult. It's a complicated thing, it's very complicated to explain it and it's an all day thing. It'll bend your mind left and right. Yeah, it's really something pretty deep Okay.
Josh Fertel
30:52
So now the most important thing somebody wants to get in touch with you, jill. How do they do it? What's the best way?
Jill Santos
30:57
The Somebody wants to get in touch with you, jill. How do they do it? What's the best way? The best way is give me a call. I'm open from 10 to 6, monday through Friday. Saturdays 10 to 2.
Josh Fertel
31:03
Okay.
Jill Santos
31:04
Sundays and holidays, usually off Phone number, but the phone number is 561-248-1721. Email my email is jillallaboutmedicarefl, as in Florida, at gmail.com.
Josh Fertel
31:20
Very good, very good. Give the phone number one more time.
Jill Santos
31:23
And the phone number is 561-248-1721. Thank you so much for having me today. You're welcome. Thanks for the work you do.
Josh Fertel
31:30
It's important.
Jill Santos
31:30
Yes, it is.
Josh Fertel
31:31
A lot of people. Health insurance is crazy, all the things that have to be, you have to know, and thank you for sort of simplifying it as best as you can, but really it really comes down to the one-on-one conversation with your client.
Jill Santos
31:48
It's really important. You know when you can call the marketplace all day long but, they're order takers. They're not licensed, so they're not really doing anything to support you. And that's why it's so important to have a personal Exactly To get the plan that works best. So they can break it down for you and I spend hours sometimes I really shouldn't, but they make it so confusing. So sometimes my heart, I'm a sympathizer. I spend way too much time for people that are really wanting to know it.
Josh Fertel
32:15
Right.
Jill Santos
32:15
But then I say you know, if you're very, you're asking a lot of good questions. Why don't you become a licensed agent? There's plenty of licensed agents, there's plenty of pie for everybody, is what I'm saying. But, I do my best, I give it my best and you know, if I don't have the answer, we find the answer.
Josh Fertel
32:31
You have the passion. That's the most important thing. That Thank you. Thanks for coming back. I hope we get the message across to as many people as possible. Yes, and we look forward to seeing you again.
Jill Santos
32:42
Give us a call. Open enrollment's coming.
Josh Fertel
32:44
There you go. So thank you, November 1st, thank you so much November 1st.
Jill Santos
32:46
Yeah, and this gal's a no hassle. I'm a local agent. If you want a quote, you got a quote, just give me a call.
Josh Fertel
32:58
Thank you for listening today. Please follow us on Facebook and LinkedIn, and you can check us out at theangrybiller.com.