Emory Healthcare Network (EHN) Advantage is designed to deliver comprehensive care and coverage to seniors to keep them at their healthiest.
Steve Lineberry, General Manager of Emory Healthcare Network Advantage, and Chuck Chaput, Executive Vice President, Medicare Compare USA, are here to share advice and tips on turning 65 and understanding your medicare options.
Turning 65 and Your Medicare Options
Guest
: Steve Lineberry & Chuck Chaput
From the Show: Emory Healthcare Consumer
Transcription:
Bill Klaproth (Host): As you approach 65, Medicare is in your future, so what do you need to know? What are your options? Here to share the key things you need to know about your Medicare options, is Steve Lineberry, General Manager of Emory Healthcare Network Advantage and Chuck Chaput, Executive Vice President, Medicare Compare, USA. Steve and Chuck, thank you, for being on with us. For people about to turn 65, let’s go through some key things they need to know. Let’s start with the components of Medicare. Chuck, can you explain that to us?
Chuck Chaput (Guest): Absolutely. Medicare is comprised for four basic components – well, there are four different types of Medicare, if you will. There is A, B, C, and D. Medicare Part A refers to hospital services. Medicare Part B refers to physician and outpatient services. Medicare Part C refers to Medicare Advantage Plans, which are plans that have a contract with the Medicare program – and we can talk more about that in a moment. And then, Medicare Part D is Medicare prescription drug plans, which provide prescription benefits for people’s medications.
Bill: How does someone determine their Medicare eligibility?
Chuck: Great question. Medicare eligibility – first of all, to be eligible for Medicare the more traditional way would be somebody that has contributed to Medicare for a total of 40 quarter, or 10 years, generally through payroll deduction. Or, they can also do that through their spouse’s contribution to Medicare. If somebody has contributed for 10 years to the Medicare trust fund, they will be eligible generally speaking, for Medicare Part A when they reach age 65. And then Part B of Medicare, which is medical and physician services, that’s GENERALLY available if they choose to elect those benefits to begin when they reach 65.
The question that will then probably come up would be “why would somebody choose to delay or enact their Medicare benefits when reaching 65?” That generally, is associated with somebody who is still working and drawing some type of health insurance through their employer or their spouse’s employer. Often times, a person may get fairly rich benefits through their employer, and they may decide to postpone their Medicare eligibility until a later time. They may decide to work past 65, is a very common thing these days.
Bill: Well, we are working longer these days. What are the different types of Medicare insurance we need to be aware of?
Chuck: Absolutely, absolutely. And if I could, before I dive into that, there are a couple of things that I wanted just to highlight – because I think a common thing has to do with what are the costs of Medicare benefits, and I didn’t hit on that. One thing I would mention is if somebody has contributed to Medicare for those 40 quarters, the Part A of Medicare, which is hospitalization, will be provided at no monthly premium. Medicare Part B, which is the physician services, would generally be at the cost of $134, which is usually drawn out of a person’s social security check.
To be eligible for any of the Medicare insurance plans that we’ll talk about now, the person would need to have Medicare Part A and Medicare Part B in place, so when you’re filling out the application for Medicare of any kind, they’re going to ask you what is your Medicare Part A effective date and what is your Medicare Part B effective date? Those are really important that you sort that out. The best place to start on that would be to contact your social security office, and I would suggest doing that about 4 to 6 months before turning 65, to determine what your options and timing would be. If you have coverage through your employer or your spouse’s employer and you’re trying to factor that in, the best thing to do would be to talk to the employer’s human resources department or plan administrator to better understand the Medicare benefits they make available to employees or spouses of employees. Those are the go-to resources when you’re getting close to that magical – age 65, and you become eligible for Medicare.
When we talk about the different types of Medicare insurance, there are basically four different types of Medicare insurance that a person can go down – or path they can go down. There is the employer Medicare coverage, which would again, be a plan that would be provided by an employer. Approximately 20 to 25% of Americans have some type of Medicare health plan offered through their or their spouse’s employer. Often times, those benefits may include added benefits that are not available on other products that are available in the marker. They’re basically richer benefits because they are being subsidized partly or in whole by the employer.
Secondly, another type of insurance that’s available would be the Medicare supplement plan, which is referred to as a Medigap plan, oftentimes. Those plans are designed to work in sync with original Medicare. Original Medicare will cover, on average, about 20% -- I’m sorry, about 80% of a person’s Medicare-approved health care services, and then you would purchase a supplement or Medigap plan to cover the 20% that those plans do not cover.
The next type of insurance that a person can consider would be a Medicare Advantage Plan, and these are offered by private insurance companies that have a contract with the Federal Medicare Program. What makes the Advantage Plans often very attractive to people is a couple of things. Number one, the Medicare Advantage Plans often times feature low, or even $0 plan premiums – monthly premiums, and that’s because that plan has a contract with the Federal Government, so they are receiving funds directly from Medicare to cover the vast majority of the costs associated with that plan’s benefits.
The other thing about Advantage Plans is they oftentimes include additional plan benefits, such as preventative dental, eye exams, hearing aids, eyeglasses, things of that nature. With Emory Healthcare specifically, Emory has locations called Care Coordination Centers that Steve can talk about here in a moment, that provide additional services that are available for Emory patients that are enrolled in any of the Medicare Advantage Plans that are accepted by Emory Healthcare. Steve, could elaborate a little bit more on those Care Coordination Centers and the value they provide patients?
Steve Lineberry (Guest): Yeah. Here at Emory, we’re partnered with the Medicare Advantage Pairs to offer additional resources for their patient – for their members. We’ve developed Coordinated Care Centers essentially staffed with physicians, nurse practitioners, patient navigators, and case managers. These are centers where we're doing the evidenced-based screening. We’re doing preventative care, and education and counseling for patients to essentially better control chronic illnesses and also, offer them a comprehensive annual exam. These are sort of like an executive physical where a patient comes in and spends anywhere between an hour to an hour and a half with our clinical staff. We’re really doing a head to toe exam and speaking with the patient not just about their physical itself, but also, just generally about how things are going for them, understanding what’s going on at home – what’s driving their healthcare and their health status.
We really work with them then on an outgoing basis if they do need more care over time, to improve their chronic illnesses. Some of the diseases we focus on include CHF, CKD, COPD. We work a lot with patients that have diabetes – some require wound care. We’re doing this on a continual basis for these patients that need it to try to work with them to get them healthy. And then as you age, your physical self-changes over time, right? We work with these patients on an ongoing basis to give them the best life that they can have. These are additional resources that when you’re a Medicare Advantage patient, you have access to at Emory.
Bill: Well, that’s really good information, and thanks for sharing that with us, Steve. Chuck and Steve, It sounds like there are a lot of options out there. I know you were just talking about the employer Medicare coverage, the Medigap Plan, the Medicare Advantage Plan. It sounds like there is no right Medicare Plan Solution for everyone. Is that right, Chuck? How do you know it’s right for you?
Chuck: That’s a really good point, Bill. The Medicare Advantage Plans can be a really great fit for patients that are coming off of an employer plan because it’s very common these days to have copayments when you access physician services or outpatient services. These plans are structured in the same kind of cost-sharing structure. They do that so that they are able to depress that premium – get that monthly premium down for the members. As Steve was just talking, these plans provide a lot of value-added services that are generally not available under traditional Medicare when you have a Medigap plan that fills in the gaps of Medicare.
On the flip side, sometimes people would prefer paying a higher monthly premium to get a Medicare supplement plan so that they don’t have as many copays. It really truly varies depending on what the person is trying to accomplish, and this is really important, they need to make a list of all of the healthcare providers that they use – physicians, services, any healthcare services that they use to make sure that whatever option they choose, all of their providers are going to be in network.
And then the other thing I always recommend is to make a list of the prescription medications a person chooses because especially if you are considering an Advantage Plan, most of the Advantage Plans these days – all of the HMOs and PPO Medicare Advantage Plans – if you choose a plan’s HMO or PPO, you are then required to choose that plan’s Medicare Prescription Drug Plan. It’s important that you choose a health plan – if you’re choosing an Advantage Plan – that covers your specific medications because if you have to pay full retail for your medications, that will substantially add to your annual out of pocket costs. As you said, there’s really no one solution right for everyone. The important thing is to talk to a professional that represents various options that can help you sort all of that out.
Bill: Well, Steven and Chuck, thank you so much, for your time today. We’ve gone over a lot of information, so if you have more questions, please visit EmoryHealthcare.org/Medicare, that’s EmoryHealthcare.org/Medicare. You can also call (855) 256-1501, (855) 256-1501. You’re listening to Advancing your Health with Emory Healthcare. I’m Bill Klaproth. Thanks for listening.
Bill Klaproth (Host): As you approach 65, Medicare is in your future, so what do you need to know? What are your options? Here to share the key things you need to know about your Medicare options, is Steve Lineberry, General Manager of Emory Healthcare Network Advantage and Chuck Chaput, Executive Vice President, Medicare Compare, USA. Steve and Chuck, thank you, for being on with us. For people about to turn 65, let’s go through some key things they need to know. Let’s start with the components of Medicare. Chuck, can you explain that to us?
Chuck Chaput (Guest): Absolutely. Medicare is comprised for four basic components – well, there are four different types of Medicare, if you will. There is A, B, C, and D. Medicare Part A refers to hospital services. Medicare Part B refers to physician and outpatient services. Medicare Part C refers to Medicare Advantage Plans, which are plans that have a contract with the Medicare program – and we can talk more about that in a moment. And then, Medicare Part D is Medicare prescription drug plans, which provide prescription benefits for people’s medications.
Bill: How does someone determine their Medicare eligibility?
Chuck: Great question. Medicare eligibility – first of all, to be eligible for Medicare the more traditional way would be somebody that has contributed to Medicare for a total of 40 quarter, or 10 years, generally through payroll deduction. Or, they can also do that through their spouse’s contribution to Medicare. If somebody has contributed for 10 years to the Medicare trust fund, they will be eligible generally speaking, for Medicare Part A when they reach age 65. And then Part B of Medicare, which is medical and physician services, that’s GENERALLY available if they choose to elect those benefits to begin when they reach 65.
The question that will then probably come up would be “why would somebody choose to delay or enact their Medicare benefits when reaching 65?” That generally, is associated with somebody who is still working and drawing some type of health insurance through their employer or their spouse’s employer. Often times, a person may get fairly rich benefits through their employer, and they may decide to postpone their Medicare eligibility until a later time. They may decide to work past 65, is a very common thing these days.
Bill: Well, we are working longer these days. What are the different types of Medicare insurance we need to be aware of?
Chuck: Absolutely, absolutely. And if I could, before I dive into that, there are a couple of things that I wanted just to highlight – because I think a common thing has to do with what are the costs of Medicare benefits, and I didn’t hit on that. One thing I would mention is if somebody has contributed to Medicare for those 40 quarters, the Part A of Medicare, which is hospitalization, will be provided at no monthly premium. Medicare Part B, which is the physician services, would generally be at the cost of $134, which is usually drawn out of a person’s social security check.
To be eligible for any of the Medicare insurance plans that we’ll talk about now, the person would need to have Medicare Part A and Medicare Part B in place, so when you’re filling out the application for Medicare of any kind, they’re going to ask you what is your Medicare Part A effective date and what is your Medicare Part B effective date? Those are really important that you sort that out. The best place to start on that would be to contact your social security office, and I would suggest doing that about 4 to 6 months before turning 65, to determine what your options and timing would be. If you have coverage through your employer or your spouse’s employer and you’re trying to factor that in, the best thing to do would be to talk to the employer’s human resources department or plan administrator to better understand the Medicare benefits they make available to employees or spouses of employees. Those are the go-to resources when you’re getting close to that magical – age 65, and you become eligible for Medicare.
When we talk about the different types of Medicare insurance, there are basically four different types of Medicare insurance that a person can go down – or path they can go down. There is the employer Medicare coverage, which would again, be a plan that would be provided by an employer. Approximately 20 to 25% of Americans have some type of Medicare health plan offered through their or their spouse’s employer. Often times, those benefits may include added benefits that are not available on other products that are available in the marker. They’re basically richer benefits because they are being subsidized partly or in whole by the employer.
Secondly, another type of insurance that’s available would be the Medicare supplement plan, which is referred to as a Medigap plan, oftentimes. Those plans are designed to work in sync with original Medicare. Original Medicare will cover, on average, about 20% -- I’m sorry, about 80% of a person’s Medicare-approved health care services, and then you would purchase a supplement or Medigap plan to cover the 20% that those plans do not cover.
The next type of insurance that a person can consider would be a Medicare Advantage Plan, and these are offered by private insurance companies that have a contract with the Federal Medicare Program. What makes the Advantage Plans often very attractive to people is a couple of things. Number one, the Medicare Advantage Plans often times feature low, or even $0 plan premiums – monthly premiums, and that’s because that plan has a contract with the Federal Government, so they are receiving funds directly from Medicare to cover the vast majority of the costs associated with that plan’s benefits.
The other thing about Advantage Plans is they oftentimes include additional plan benefits, such as preventative dental, eye exams, hearing aids, eyeglasses, things of that nature. With Emory Healthcare specifically, Emory has locations called Care Coordination Centers that Steve can talk about here in a moment, that provide additional services that are available for Emory patients that are enrolled in any of the Medicare Advantage Plans that are accepted by Emory Healthcare. Steve, could elaborate a little bit more on those Care Coordination Centers and the value they provide patients?
Steve Lineberry (Guest): Yeah. Here at Emory, we’re partnered with the Medicare Advantage Pairs to offer additional resources for their patient – for their members. We’ve developed Coordinated Care Centers essentially staffed with physicians, nurse practitioners, patient navigators, and case managers. These are centers where we're doing the evidenced-based screening. We’re doing preventative care, and education and counseling for patients to essentially better control chronic illnesses and also, offer them a comprehensive annual exam. These are sort of like an executive physical where a patient comes in and spends anywhere between an hour to an hour and a half with our clinical staff. We’re really doing a head to toe exam and speaking with the patient not just about their physical itself, but also, just generally about how things are going for them, understanding what’s going on at home – what’s driving their healthcare and their health status.
We really work with them then on an outgoing basis if they do need more care over time, to improve their chronic illnesses. Some of the diseases we focus on include CHF, CKD, COPD. We work a lot with patients that have diabetes – some require wound care. We’re doing this on a continual basis for these patients that need it to try to work with them to get them healthy. And then as you age, your physical self-changes over time, right? We work with these patients on an ongoing basis to give them the best life that they can have. These are additional resources that when you’re a Medicare Advantage patient, you have access to at Emory.
Bill: Well, that’s really good information, and thanks for sharing that with us, Steve. Chuck and Steve, It sounds like there are a lot of options out there. I know you were just talking about the employer Medicare coverage, the Medigap Plan, the Medicare Advantage Plan. It sounds like there is no right Medicare Plan Solution for everyone. Is that right, Chuck? How do you know it’s right for you?
Chuck: That’s a really good point, Bill. The Medicare Advantage Plans can be a really great fit for patients that are coming off of an employer plan because it’s very common these days to have copayments when you access physician services or outpatient services. These plans are structured in the same kind of cost-sharing structure. They do that so that they are able to depress that premium – get that monthly premium down for the members. As Steve was just talking, these plans provide a lot of value-added services that are generally not available under traditional Medicare when you have a Medigap plan that fills in the gaps of Medicare.
On the flip side, sometimes people would prefer paying a higher monthly premium to get a Medicare supplement plan so that they don’t have as many copays. It really truly varies depending on what the person is trying to accomplish, and this is really important, they need to make a list of all of the healthcare providers that they use – physicians, services, any healthcare services that they use to make sure that whatever option they choose, all of their providers are going to be in network.
And then the other thing I always recommend is to make a list of the prescription medications a person chooses because especially if you are considering an Advantage Plan, most of the Advantage Plans these days – all of the HMOs and PPO Medicare Advantage Plans – if you choose a plan’s HMO or PPO, you are then required to choose that plan’s Medicare Prescription Drug Plan. It’s important that you choose a health plan – if you’re choosing an Advantage Plan – that covers your specific medications because if you have to pay full retail for your medications, that will substantially add to your annual out of pocket costs. As you said, there’s really no one solution right for everyone. The important thing is to talk to a professional that represents various options that can help you sort all of that out.
Bill: Well, Steven and Chuck, thank you so much, for your time today. We’ve gone over a lot of information, so if you have more questions, please visit EmoryHealthcare.org/Medicare, that’s EmoryHealthcare.org/Medicare. You can also call (855) 256-1501, (855) 256-1501. You’re listening to Advancing your Health with Emory Healthcare. I’m Bill Klaproth. Thanks for listening.
