Many people look forward to making the move to Medicare. But first, it’s essential to understand the basics because you have some important choices to make before arriving at the option that best fits your needs.
Ivan Lopez, a licensed agent with Van Berg Insurance Services who works with MarinHealth partner Canopy Health, specializes in educating people about their Medicare options. In this podcast, he provides an overview of Medicare and offers advice on how to transition onto the program, walking you through what you need to know–and do–before signing up.
Selected Podcast
Aging Into Medicare: What Do I Need to Know?
Featured Speaker:
Ivan Lopez
Ivan Lopez has been educating clients and agents about Medicare products for 13 years. He believes in teaching the basics of Medicare to make it simple for everyone to understand. He has been educating Medicare 101 seminars 3 times a month for the past 7 years, as well as managing and training agents to do the same. He values his opportunity to educate the senior population. Transcription:
Bill Klaproth (Host): So, you’re aging into Medicare. There’s a lot to process, a lot to research, a lot to understand. So, what is it that you really need to know? Let’s find out with Ivan Lopez, a licensed agent with Van Berg Insurance Services.
This is The Healing Podcast brought to you by MarinHealth. I’m Bill Klaproth. Normally, we’d be talking with a healthcare provider but today, we’re going to talk with Ivan who is a licensed agent with Van Berg Insurance Services. They work with MarinHealth’s partner Canopy Health. Ivan is joining us to day to help you make the best decisions when selecting an insurance provider. Ivan, thank you for your time. We appreciate it. It is great to talk with you. First off, can you give us some brief background on yourself?
Ivan Lopez (Guest): Absolutely. So, my name is Ivan. I’ve been doing Medicare for going on 14 years. I am an insurance broker. I work with various insurance companies and medical groups. And for the last seven years, I do strictly education which is Medicare 101 four times a week. So, I kind of know my way around stuff.
Host: You absolutely do. You are the right man to talk to. Perfect. So, Ivan, what is the age then to start thinking about Medicare and prepping for applying?
Ivan: Usually, it’s about the age of 64 and a half. Your Medicare will come to you part A and B three months prior to your 65th birthday. So, right around 64 ½ is when you want to start looking out for all your Medicare stuff.
Host: And then how do you qualify for this?
Ivan: You have to pay FICA taxes for 10 years or 40 quarters. So, that qualifies you and your wife if you are married or a household, as long as they work for 10 years or 40 quarters.
Host: Okay very interesting. And you said 64 ½ is when we really start to have to prepare for this. do you have to apply by a certain date or age and what if you don’t? Can you still get Medicare later?
Ivan: Yes, you can so usually, enrollment into parts A and B is automatic at any age so if you are disabled for 24 months, you don’t have to be the age of 65. Certain young people also get it through disability.
Host: Okay so you just mentioned part A and B. Can you explain the parts of Medicare A, M and then we hear part C and D?
Ivan: Absolutely. So, your Medicare part A and part B is the foundation of Medicare. So, your part A is your hospital coverage. Your part B is your doctor coverage. The Center for Medicare and Medicaid Services, they administer parts A and B. Part D is prescription drug coverage which is by approved private insurance companies that are contracted with Medicare. So, Medicare itself doesn’t offer part D, the medication coverage. And a combination of A, B and D is known as Medicare part C which is your HMO types of plans or PPO types of plans. It’s just a managed healthcare plan. That’s what part C is.
Host: Okay and then what is Medicare Advantage?
Ivan: Medicare Advantage is Medicare part C.
Host: Oh okay so, that’s what Medicare part C is called. It’s called Medicare Advantage. Okay. So, then with all of these parts and components, are there any healthcare issues that are not covered by Medicare?
Ivan: As far as treatments themselves, there’s a long list. I don’t know every procedure that’s covered or not covered. But as far as when you are enrolling into a health plan, as of right now, to enroll into a Medicare part C, the only declining question is if you have ESRD which is end stage renal disease which is kidney dialysis. But that question is going away in 2020 so, that question wont be on the applications for 2021. So, would be the only thing that would disqualify you from enrolling into a Medicare part C.
Host: Okay. Got it. So, then as far as part D goes, the prescriptions part of this; if you don’t apply by a certain date or age, are there penalties?
Ivan: Yes. So, you have three months from your 65th birthday to enroll into a part D or else you will have a penalty that will last the rest of your life. It’s one percent of the national average so it breaks down to about three dollars and twenty seven cents per year penalty that will last for the rest of your life. So, yes, you will have a penalty if you do not enroll.
Host: You better do it then.
Ivan: Yes, what happens is, I run into a lot of folks that don’t have a part D plan because they don’t take a single medication. They’re healthy. They eat healthy and go to the gym. And they don’t have a part D plan and I have to tell them you’re going to have a penalty. They say, “Well that’s not fair. I don’t take any medications. Why are they penalizing for me for being healthy?” And I tell them I’m just the mailman bringing the news. That’s all I can do.
Host: Don’t kill the messenger.
Ivan: Exactly.
Host: Right. So, when it comes to seeing a physician Ivan, do all physicians take Medicare and do they usually take all of the Medicare Advantage plans?
Ivan: No. So, it’s up to each individual doctor. He may or may not accept Medicare assignment. That’s up to them. So, you want to check with your primary doctor and make sure all your specialists are in a plan before you enroll into a health plan. They don’t have to. Some do take original Medicare. Some don’t. Some take Medicare Advantage part Cs and some don’t. So, every doctor is different.
Host: So, it sounds like it’s smart to check to see before applying for Medicare if your doctor takes it?
Ivan: Absolutely. And us, as an agent, broker, I can be out with as far as the plan that takes all your medications, I can help you out with looking makes sure all your docs and specialists are in any certain health plan that you are wanting to enroll into.
Host: Speaking of the healthcare plan, what if you choose a plan that in a year doesn’t really work for you or you don’t like the benefits or coverage; then what?
Ivan: So, on a Medicare part C Advantage plan, you have what’s known as the annual election period. October 15th to December 7th of every year, you have the opportunity to shop for a plan for the coming year. So, any decision you make in October 15th to December 7th will take effect for you the first of the coming year. So, you have every year during that period, to shop for a different health plan. Obviously, there are special election periods. Let’s just say you move out of the service area to another state or another county, then you have a what’s known as special election period to enroll into a health plan outside of those election periods.
Host: So, you just mentioned moving to another state or county; when it comes to Medicare, does it matter where you live?
Ivan: Yes. So, when it comes to the Medicare part C plans, they are built on the county that you live in. So, the plan is built if for example you live in the Contra Costa County or Santa Clara County, the Medicare Advantage are specific to each county. Now when it comes to a Medicare supplement or a Medigap policy; those do not have a network. The only thing that’s going to be the difference from county to state is the premium you pay.
Host: Wow, that’s really interesting. So, does that mean you could pay more than what you paid prior to Medicare for the same or similar coverage just by where you live?
Ivan: Correct.
Host: So, that’s interesting. Let me ask you this. Do employers help offset some of these costs or cover some of these costs? How should someone check?
Ivan: Well these are independent individual plans. These are not group retiree plans. So, that’s kind of a difficult question. There is some employers that say heh if you take an early retirement, we’ll give you a subsidy to help pay for your medical on your own. But from my experience, employer plans, they do not pay. These are individual market plans.
Host: And then when it comes time to select a plan; how do you do that? How do you go about that?
Ivan: A lot of research. First of all, you got to get all your ducks in a row, make sure all your medications are covered by your plan and then when you’re deciding into a plan, there’s very many avenues to enroll. What I’m going to say is you usually want to enroll through a broker because we can help you out as far as questions, concerns, things like that. You can enroll directly with the company. You can enroll on www.medicare.gov, that’s the public website. You can enroll there directly. You could call each company over the phone and enroll with them directly. So, there’s many ways of enrolling.
Host: And then once a selection is made, do the plans ever make changes that could impact your coverage? Will they change a plan on you and if so, what can you do about those changes?
Ivan: Yes. So, the Medicare part C Advantage plans, those benefits are built on a calendar year. So the plan may make changes for the coming year. What each company will do by law, they have to have what’s known as the annual notice of change letter in the patient’s mailbox no later than October 1st. And what that does, it tells you exactly what’s changing in your plan for next year. That way you can make an informed decision if you want to change during the annual election period of October 15th to December 7th. So, yes, the do change. Some may change as far as premiums, co-payments, doctor networks, things like that, but it’s in there for you to make a change. They let you know way ahead of time for you to make an informed decision to make a change.
Host: So, there’s a lot of leg work and research and deadlines and it sounds like forms and plans to pick out. This sounds like it can be quite complicated. And seems to require making very careful and well thought out decisions. That is where you can be helpful, is that right?
Ivan: Absolutely. So, again, like I said, I am a broker. I work with various companies, different medical groups and I’m neutral on the health plans. Not everybody is the same. Not everybody wears the same size shoe. So, what we like to do is tailor a plan that works for you, for your medications, your doctors and all that kind of stuff just to make sure you are in the right plan and we get paid by the insurance companies based on enrollment. So, my services to you as a consumer are free. I know that sounds crazy, but I love to talk to people. This is what I do all day long. I want to talk to people. I want to help people. And I get paid by the insurance companies.
Host: Oh that’s great to know. So, then what is the best first step for someone?
Ivan: First step is probably contacting a local broker or start the research on www.medicare.gov. Start looking at your medications. I keep the same medications because that is the most important thing. You don’t go to the doctor every day, you don’t go to the specialist every day, you don’t go to the hospital every day; but medications are taken every day. So, what happens is a lot of consumers go on there and they see a plan or a commercial and that plan has a zero premium and what’s the first thing they do? They want to call up and enroll in that zero premium plan. And by mid-year, they realize they’re paying a lot of money on their medications because they are on a higher formulary tier than what they thought or they knew in the research and that zero premium plan cost them five thousand dollars in medications because they didn’t do the proper leg work to do the research and to get into a plan. Or you could do your research on www.medicare.gov, or contact your local broker where you live or give me a call or an email and I’m here to help you folks out.
Host: That makes sense. So, you just gave out a great website and then as you said, it sounds like it’s smart for someone to sit down with a licensed plan neutral adviser like yourself.
Ivan: We charge no fees. Like I said, we’re here to help you. We love educating especially me. I love educating. I’ve been doing like I said for seven years educating, sales going on 14 years. I also manage and train a key team of agents to do exactly what I do.
Host: So then this all sounds good. How does someone enroll and is it easy to do that online or do you have to call or go in somewhere?
Ivan: Right now with the whole COVID thing, it’s more than ever it’s online enrollment. I can do an enrollment in five minutes, less than five minutes. We have EFs where I can send you an email, you can open your phone, type in your name in a text message on your phone that you are enrolled. I could send you an email where you open it up, type in your name and you’re enrolled. There’s various ways to do it. I could scan and email you an application, you fill it out, fax it back to me. Some companies I can be on the phone with the prospect and me and then they’ll do a online enrollment. And last but not least, snail mail. I could put a packet in the mail for you and you could mail it back to me. Anyway whatever works for you, I’m willing to make it happen. Whatever is easiest for the patient.
Host: So, a lot of different ways to enroll. Ivan, thank you so much for your time. This has really been informative and there’s a lot of ground to cover when it comes to Medicare. So, thank you so much for your time. We appreciate it.
Ivan: Absolutely.
Host: That’s Ivan Lopez and to learn more, please visit www.mymarinhealth.org and if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is The Healing Podcast brought to you by MarinHealth. I’m Bill Klaproth. Thanks for listening.
Bill Klaproth (Host): So, you’re aging into Medicare. There’s a lot to process, a lot to research, a lot to understand. So, what is it that you really need to know? Let’s find out with Ivan Lopez, a licensed agent with Van Berg Insurance Services.
This is The Healing Podcast brought to you by MarinHealth. I’m Bill Klaproth. Normally, we’d be talking with a healthcare provider but today, we’re going to talk with Ivan who is a licensed agent with Van Berg Insurance Services. They work with MarinHealth’s partner Canopy Health. Ivan is joining us to day to help you make the best decisions when selecting an insurance provider. Ivan, thank you for your time. We appreciate it. It is great to talk with you. First off, can you give us some brief background on yourself?
Ivan Lopez (Guest): Absolutely. So, my name is Ivan. I’ve been doing Medicare for going on 14 years. I am an insurance broker. I work with various insurance companies and medical groups. And for the last seven years, I do strictly education which is Medicare 101 four times a week. So, I kind of know my way around stuff.
Host: You absolutely do. You are the right man to talk to. Perfect. So, Ivan, what is the age then to start thinking about Medicare and prepping for applying?
Ivan: Usually, it’s about the age of 64 and a half. Your Medicare will come to you part A and B three months prior to your 65th birthday. So, right around 64 ½ is when you want to start looking out for all your Medicare stuff.
Host: And then how do you qualify for this?
Ivan: You have to pay FICA taxes for 10 years or 40 quarters. So, that qualifies you and your wife if you are married or a household, as long as they work for 10 years or 40 quarters.
Host: Okay very interesting. And you said 64 ½ is when we really start to have to prepare for this. do you have to apply by a certain date or age and what if you don’t? Can you still get Medicare later?
Ivan: Yes, you can so usually, enrollment into parts A and B is automatic at any age so if you are disabled for 24 months, you don’t have to be the age of 65. Certain young people also get it through disability.
Host: Okay so you just mentioned part A and B. Can you explain the parts of Medicare A, M and then we hear part C and D?
Ivan: Absolutely. So, your Medicare part A and part B is the foundation of Medicare. So, your part A is your hospital coverage. Your part B is your doctor coverage. The Center for Medicare and Medicaid Services, they administer parts A and B. Part D is prescription drug coverage which is by approved private insurance companies that are contracted with Medicare. So, Medicare itself doesn’t offer part D, the medication coverage. And a combination of A, B and D is known as Medicare part C which is your HMO types of plans or PPO types of plans. It’s just a managed healthcare plan. That’s what part C is.
Host: Okay and then what is Medicare Advantage?
Ivan: Medicare Advantage is Medicare part C.
Host: Oh okay so, that’s what Medicare part C is called. It’s called Medicare Advantage. Okay. So, then with all of these parts and components, are there any healthcare issues that are not covered by Medicare?
Ivan: As far as treatments themselves, there’s a long list. I don’t know every procedure that’s covered or not covered. But as far as when you are enrolling into a health plan, as of right now, to enroll into a Medicare part C, the only declining question is if you have ESRD which is end stage renal disease which is kidney dialysis. But that question is going away in 2020 so, that question wont be on the applications for 2021. So, would be the only thing that would disqualify you from enrolling into a Medicare part C.
Host: Okay. Got it. So, then as far as part D goes, the prescriptions part of this; if you don’t apply by a certain date or age, are there penalties?
Ivan: Yes. So, you have three months from your 65th birthday to enroll into a part D or else you will have a penalty that will last the rest of your life. It’s one percent of the national average so it breaks down to about three dollars and twenty seven cents per year penalty that will last for the rest of your life. So, yes, you will have a penalty if you do not enroll.
Host: You better do it then.
Ivan: Yes, what happens is, I run into a lot of folks that don’t have a part D plan because they don’t take a single medication. They’re healthy. They eat healthy and go to the gym. And they don’t have a part D plan and I have to tell them you’re going to have a penalty. They say, “Well that’s not fair. I don’t take any medications. Why are they penalizing for me for being healthy?” And I tell them I’m just the mailman bringing the news. That’s all I can do.
Host: Don’t kill the messenger.
Ivan: Exactly.
Host: Right. So, when it comes to seeing a physician Ivan, do all physicians take Medicare and do they usually take all of the Medicare Advantage plans?
Ivan: No. So, it’s up to each individual doctor. He may or may not accept Medicare assignment. That’s up to them. So, you want to check with your primary doctor and make sure all your specialists are in a plan before you enroll into a health plan. They don’t have to. Some do take original Medicare. Some don’t. Some take Medicare Advantage part Cs and some don’t. So, every doctor is different.
Host: So, it sounds like it’s smart to check to see before applying for Medicare if your doctor takes it?
Ivan: Absolutely. And us, as an agent, broker, I can be out with as far as the plan that takes all your medications, I can help you out with looking makes sure all your docs and specialists are in any certain health plan that you are wanting to enroll into.
Host: Speaking of the healthcare plan, what if you choose a plan that in a year doesn’t really work for you or you don’t like the benefits or coverage; then what?
Ivan: So, on a Medicare part C Advantage plan, you have what’s known as the annual election period. October 15th to December 7th of every year, you have the opportunity to shop for a plan for the coming year. So, any decision you make in October 15th to December 7th will take effect for you the first of the coming year. So, you have every year during that period, to shop for a different health plan. Obviously, there are special election periods. Let’s just say you move out of the service area to another state or another county, then you have a what’s known as special election period to enroll into a health plan outside of those election periods.
Host: So, you just mentioned moving to another state or county; when it comes to Medicare, does it matter where you live?
Ivan: Yes. So, when it comes to the Medicare part C plans, they are built on the county that you live in. So, the plan is built if for example you live in the Contra Costa County or Santa Clara County, the Medicare Advantage are specific to each county. Now when it comes to a Medicare supplement or a Medigap policy; those do not have a network. The only thing that’s going to be the difference from county to state is the premium you pay.
Host: Wow, that’s really interesting. So, does that mean you could pay more than what you paid prior to Medicare for the same or similar coverage just by where you live?
Ivan: Correct.
Host: So, that’s interesting. Let me ask you this. Do employers help offset some of these costs or cover some of these costs? How should someone check?
Ivan: Well these are independent individual plans. These are not group retiree plans. So, that’s kind of a difficult question. There is some employers that say heh if you take an early retirement, we’ll give you a subsidy to help pay for your medical on your own. But from my experience, employer plans, they do not pay. These are individual market plans.
Host: And then when it comes time to select a plan; how do you do that? How do you go about that?
Ivan: A lot of research. First of all, you got to get all your ducks in a row, make sure all your medications are covered by your plan and then when you’re deciding into a plan, there’s very many avenues to enroll. What I’m going to say is you usually want to enroll through a broker because we can help you out as far as questions, concerns, things like that. You can enroll directly with the company. You can enroll on www.medicare.gov, that’s the public website. You can enroll there directly. You could call each company over the phone and enroll with them directly. So, there’s many ways of enrolling.
Host: And then once a selection is made, do the plans ever make changes that could impact your coverage? Will they change a plan on you and if so, what can you do about those changes?
Ivan: Yes. So, the Medicare part C Advantage plans, those benefits are built on a calendar year. So the plan may make changes for the coming year. What each company will do by law, they have to have what’s known as the annual notice of change letter in the patient’s mailbox no later than October 1st. And what that does, it tells you exactly what’s changing in your plan for next year. That way you can make an informed decision if you want to change during the annual election period of October 15th to December 7th. So, yes, the do change. Some may change as far as premiums, co-payments, doctor networks, things like that, but it’s in there for you to make a change. They let you know way ahead of time for you to make an informed decision to make a change.
Host: So, there’s a lot of leg work and research and deadlines and it sounds like forms and plans to pick out. This sounds like it can be quite complicated. And seems to require making very careful and well thought out decisions. That is where you can be helpful, is that right?
Ivan: Absolutely. So, again, like I said, I am a broker. I work with various companies, different medical groups and I’m neutral on the health plans. Not everybody is the same. Not everybody wears the same size shoe. So, what we like to do is tailor a plan that works for you, for your medications, your doctors and all that kind of stuff just to make sure you are in the right plan and we get paid by the insurance companies based on enrollment. So, my services to you as a consumer are free. I know that sounds crazy, but I love to talk to people. This is what I do all day long. I want to talk to people. I want to help people. And I get paid by the insurance companies.
Host: Oh that’s great to know. So, then what is the best first step for someone?
Ivan: First step is probably contacting a local broker or start the research on www.medicare.gov. Start looking at your medications. I keep the same medications because that is the most important thing. You don’t go to the doctor every day, you don’t go to the specialist every day, you don’t go to the hospital every day; but medications are taken every day. So, what happens is a lot of consumers go on there and they see a plan or a commercial and that plan has a zero premium and what’s the first thing they do? They want to call up and enroll in that zero premium plan. And by mid-year, they realize they’re paying a lot of money on their medications because they are on a higher formulary tier than what they thought or they knew in the research and that zero premium plan cost them five thousand dollars in medications because they didn’t do the proper leg work to do the research and to get into a plan. Or you could do your research on www.medicare.gov, or contact your local broker where you live or give me a call or an email and I’m here to help you folks out.
Host: That makes sense. So, you just gave out a great website and then as you said, it sounds like it’s smart for someone to sit down with a licensed plan neutral adviser like yourself.
Ivan: We charge no fees. Like I said, we’re here to help you. We love educating especially me. I love educating. I’ve been doing like I said for seven years educating, sales going on 14 years. I also manage and train a key team of agents to do exactly what I do.
Host: So then this all sounds good. How does someone enroll and is it easy to do that online or do you have to call or go in somewhere?
Ivan: Right now with the whole COVID thing, it’s more than ever it’s online enrollment. I can do an enrollment in five minutes, less than five minutes. We have EFs where I can send you an email, you can open your phone, type in your name in a text message on your phone that you are enrolled. I could send you an email where you open it up, type in your name and you’re enrolled. There’s various ways to do it. I could scan and email you an application, you fill it out, fax it back to me. Some companies I can be on the phone with the prospect and me and then they’ll do a online enrollment. And last but not least, snail mail. I could put a packet in the mail for you and you could mail it back to me. Anyway whatever works for you, I’m willing to make it happen. Whatever is easiest for the patient.
Host: So, a lot of different ways to enroll. Ivan, thank you so much for your time. This has really been informative and there’s a lot of ground to cover when it comes to Medicare. So, thank you so much for your time. We appreciate it.
Ivan: Absolutely.
Host: That’s Ivan Lopez and to learn more, please visit www.mymarinhealth.org and if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is The Healing Podcast brought to you by MarinHealth. I’m Bill Klaproth. Thanks for listening.