Medicare 101 – What You Need to Know
When it comes to Medicare, confusion is the norm for most people, parts A B, C, D Advantage plans Supplement Plans HMO, PPO pff SNP was so many letters of the alphabet dancing across the page, where do you begin? What type of plan is right for you? when is the right time to enroll and how much does it cost? If you have questions about Medicare and are feeling just a little overwhelmed by it all, then you’ll want to listen to episode sixteen of Sage Aging.
This week, I chatted with Jennifer Mullins, a licensed Insurance Agent with Humana, all about the basics of Medicare. Medicare is a confusing topic for sure. In part because of all of the acronyms used to describe plan options and parts, but also because the options are so varied. The biggest take away is that the plan that is right for you may not be the plan that is right for someone else.
key things to consider when choosing a plan
- Cost – what will you pay for premiums, deductibles, co-insurance and co-payments?
- Benefits – what benefits are included in your choice of plans (vision, dental etc.)?
- Convenience – Are the plan’s network providers close to your home?
- Providers – Do your current providers accept your choice of plans?
- Prescriptions – Does the plan carry enough prescription coverage based on your anticipated needs?
For the rest of what we discussed you can listen to episode 16 or keep scrolling for the interview transcript.
To say that Medicare is confusing would be an understatement. The options are many, and it can be difficult to navigate the maze and choose the plan that’s right for you. The good news is you don’t have to navigate Medicare on your own. In this episode we cover the basics of Medicare with guest Jennifer Mullins, a licensed insurance agent with Humana.
Links & Resources
- About Jennifer Mullins
- Connect with Jennifer on facebook
- Medicare and you Handbook
- State Health Insurance Assistance Program (SHIP) – find local medicare help
- SHINE (FL SHIP program)
- Social Security Administration
- Area Agency on Aging – Find your local office
Sage Aging Episode 16
Medicare 101 – The Basics
Guest: Jennifer Mullins, Humana
Recorded July 2020
Liz Craven 00:00
When it comes to Medicare confusion is the norm for most people, parts A B, C, D Advantage plans Supplement Plans HMO, PPO pff SNP was so many letters of the alphabet dancing across the page, where do you begin? What type of plan is right for you? when is the right time to enroll and how much does it cost? If you have questions about Medicare and are feeling just a little overwhelmed by it all, then this is the podcast episode for you.
Liz Craven 00:46
Hi, everyone, and welcome back to the Sage Aging podcast. I’m your host Liz Craven. If you’re joining us for the first time, welcome. I’m really glad you’re here in this podcast. We’ll introduce you to experts in the field of aging will provide you with the information you need to make daily life easier. Like all of you, I was a family caregiver myself. And as a publisher of a senior resource guide, I understand how hard it is to come by good information. And I know that sometimes you just need to hear that everything will be okay. Our weekly conversations with industry professionals will leave you feeling confident that you’re not alone and empowered to celebrate and enjoy the aging and caregiving journey. Are you ready? Hit subscribe now. Let’s get started.
Liz Craven 01:40
Welcome back, everyone. This is Episode 16 of the Sage Aging podcast. And the first order of business today is a big thank you. We just surpassed 1000 downloads and for a new podcast was such a niche topic. That’s a pretty big deal. And I’m really proud of that and I’m thankful For you, I’m truly having a great time with this podcast and from your feedback. I even have plans for something new to complement it coming very soon. I can’t share the details just yet. But stay tuned for that announcement soon. Thank you so much for listening and spending a few minutes with me each week. I don’t think you know how much I appreciate that. And I hope that the content that I’m bringing is helpful for you. This podcast, it’s all about you the listeners. So let me know how I’m doing. What do you like and what don’t you like? What would you like to hear more of? Are there specific guests or topics that you’d like for me to pursue? I’d love to hear your thoughts on all of that. So drop me a line at info at SageAging.us or you can connect with Sage Aging on social media via Facebook, Instagram and Twitter. Now let’s move on and get to our topic. To say that Medicare is confusing would be an understatement. The options are many, and it can be difficult to navigate the maze and choose the plan that’s right for you. The good news is you don’t have to navigate Medicare on your own. There are specially trained agents and government websites and resources and nonprofit organizations available to assist you in that. My guest today is Jennifer Mullins, a licensed insurance agent with Humana for six years specializing in Medicare. Jennifer’s favorite part of her job is working one on one with seniors and serving her community. And she does that really well. You can always find her out volunteering at local organizations and food distributions. And while she’s not working, she enjoys walking around the lakes in the local area with her pups Rocky and Coco. Welcome to the show, Jennifer, thank you so much for joining me.
Jennifer Mullins 03:55
Thank you, Liz for having me on stage aging. I’m so excited to be here.
Liz Craven 04:01
Good Well, hey, you know what, we have always done a lightning round at the beginning of each episode, we kind of took a little vacation from that, with all of the content that we had to squeeze into a short episode for the elder law series. But I’d love to bring that back today with you. So do you mind if I ask a few get to know you questions?
Jennifer Mullins 04:23
Sure. I would love that.
Liz Craven 04:25
Okay, awesome. Your first question is, what is your favorite color?
Jennifer Mullins 04:31
So my favorite color is turquoise or really any shade of blue?
Liz Craven 04:38
So you’ve got that cool vibe going on? Yes. Very good. Your next question, what’s something that your parents, either your mom or your dad taught you that you’ve always carried with you?
Jennifer Mullins 04:53
Something my parents have always taught me is to always remember where I came from, and always have strong faith. I’m so grateful that my parents kept me in church and active in the church. Because Because of that, that’s like, been a foundation for me all of my life.
Liz Craven 05:11
That’s wonderful. So what did you do when you were a kid? Did you all go to church weekly and have you know, lunch afterwards? What were your traditions? Like? Yeah,
Jennifer Mullins 05:20
so we went to church every Sunday morning, Sunday night and Wednesdays, after church, you know, we would always, like have a big family lunch. I was really good friends with the pastor’s daughter. So we’re still really good friends today. And she and I would get together get to play at each other’s houses. And it just allowed me to really develop strong relationships and have a really strong faith throughout my life. That’s so awesome.
Liz Craven 05:48
I guess the next question would be obvious, but I’m going to ask it anyway. What is your favorite way to spend a Sunday afternoon
Jennifer Mullins 05:57
Well, so now That we are virtual and we’re in our homes. I love watching church on my TV in my living room. It’s kind of neat. I get to sit there with my coffee and just enjoy a peaceful morning. Usually in the afternoons I love to just relax, unwind. Something else I love doing at the end of my day, I like to get ready for my week and kind of just like set my calendar up and get organized. So kind of like a little mixture of relax and then just get ready for a brand new week.
Liz Craven 06:35
Oh, I’m so with you on getting organized for the week. I just, I’m one of those people who likes her workspace to be organized and well defined. I can’t stand it even if I’m going to work on a project. It can’t be on my desk unless I’m working on it right now. Otherwise, I’m flustered and I can’t focus on what I’m doing.
Jennifer Mullins 06:55
Yes, yes, I know that feeling.
Liz Craven 06:58
Well, that was fun. Thanks for indulging me in that little bit of fun. I really think it’s a great opportunity for our listeners to get to know us as people a little bit and just hear a little bit about the personal side before we jump into all the info. So I hope everybody is ready to take some notes and learn a little bit about Medicare. Because Wow, what a huge topic. That is. I think we could probably do an entire series just on Medicare, and not run out of things to talk about. But today, I really want to start with the basics. Medicare 101. So let’s just start from the beginning. What is Medicare?
Jennifer Mullins 07:41
Medicare is the US government’s largest health insurance program, and it serves more than 62 million people. It’s run by the Centers for Medicare and Medicaid Services. So sometimes you may hear CMS it’s part of the US Department of Health and Human Services.
Liz Craven 08:01
Sometimes people confuse Medicare with Medicaid. Can you distinguish the difference for us?
Jennifer Mullins 08:08
Yes, absolutely. So Medicare is a federal program that provides health coverage if you’re 65 or older, or under 65, and you have a disability no matter your income. Medicaid is a state and federal program that provides health coverage if you have a very low income. So if you’re eligible for both Medicare and Medicaid, oftentimes called dual eligible, you can have both.
Liz Craven 08:37
Who is eligible for Medicare and what qualifications must they meet for eligibility?
Jennifer Mullins 08:45
At age 65, you may be eligible for Medicare Parts A and B, even if you still work, and you may be eligible for premium free Medicare Part A through your spouse, although you must still qualify by age or disability. You may also be eligible for Medicare Part A and B if you’re under 65 and have a disability or in stage renal disease. Now, if you have a disability, you would need to be on disability for 24 months in order to qualify for Medicare Part B.
Liz Craven 09:18
So as it relates to all of these parts and different plans, I think that’s probably the element that confuses people the most. So let’s start with what is Original Medicare and then talk about private Medicare and describe all the parts that go along with those.
Jennifer Mullins 09:39
That’s a great question. So Original Medicare, Original Medicare is your Parts A and B. So part A helps cover your hospital cost and other inpatient cost. Part B helps cover your doctor and other outpatient cost. So together they are original metal Care and available from the federal government. Your next option would be, you here sometimes on the commercials Medicare Advantage plans, which is Medicare Part C. And that’s when you take Medicare Parts A and B, and it will equal part C, kind of like a mathematical equation.
Liz Craven 10:21
I was never good in math,
Jennifer Mullins 10:24
Me either, but Medicare Advantage is a plan that you know, they call it ma PD sometimes you’ll hear because it covers your medical and your prescription drug plans. So when you’re on a Medicare Advantage plan frequently it includes extra benefits and services. It may include prescription drug coverage Part D, and they’re oftentimes offered through private companies such as Humana, your next option would be just Original Medicare and a prescription drug plan. That’s where you would pay a monthly premium for a prescription drug. plan, and then just have your original Medicare where you would pay the 20% of the cost with your Parts A and B.
Liz Craven 11:09
So the prescription drug plan, is that something that you would purchase through a private insurance?
Jennifer Mullins 11:16
Yes, it is. So that is another. That is another plan that’s available through private companies such as Humana that you could purchase through an agent. The other option that you have is Medicare supplements. They’re often called Medigap plans and work with Original Medicare. So they’re designed to help pay some of the costs Original Medicare doesn’t pay, such as your co pays coinsurance is deductibles. Each medicare supplement insurance plan has a unique blend of benefits. So these may be attractive because they’re not limited to specific network or providers. So when I say Medicare Advantage You would think of Plan G Plan F that might sound familiar, you know, the letters of the alphabet. Again, Medicare really likes to use the ABCs.
Liz Craven 12:11
Yes, they do.
Jennifer Mullins 12:14
But those are often common. They’ve been around a long time. And those are also through private companies.
Liz Craven 12:22
So the only ones that you would get through the government would be a and b, the rest are all going to come through a private company.
Jennifer Mullins 12:31
That is correct.
Liz Craven 12:33
So when you qualify for Medicare, meaning you’re turning 65, what does the timeline look like?
Jennifer Mullins 12:42
So the timeline, they have seven months when you’re turning 65. So if you’re within three months of turning 65, you’re eligible for the Medicare initial enrollment period IEP, and can enroll in a Medicare plan, and it’s also time to start exploring Medicare If you haven’t enrolled within that first three months, so you have seven months, three months before your birthday, the month of your birthday, and three months after your birthday to make a choice, it’s important to make a choice because you don’t want to end up with a penalty for not selecting a plan.
Liz Craven 13:20
So even if you’re selecting just the Parts A and B that are provided for you, you still have to officially make that selection.
Jennifer Mullins 13:30
Correct. So the most important selection you make if you only keep Original Medicare Part A and B, you definitely want to add a prescription drug plan to it. That’s where the penalty can come into play is if you don’t have that prescription drug plan. So if anything, most importantly, make sure you choose a prescription drug plan if you decide not to go with a Medicare Advantage plan or a Medicare supplement.
Liz Craven 13:57
So the prescription plan, although It has to be purchased separately, it’s not really optional?
Jennifer Mullins 14:04
No, it’s not optional. I mean, you could not get one. But if you ever decide later in life to get one, the penalty will just be much larger than if you waited a year or two years. For example, I’ve seen situations where somebody in their 80s didn’t really know very much about the penalty. And they decided they want a drug plan, but the penalty is just so high right now, that it just may not be advantageous for them.
Liz Craven 14:33
So we’re talking like a financial penalty?
Jennifer Mullins 14:36
Yes. A financial penalty. Yes.
Liz Craven 14:38
Is that a one time penalty or is that something that’s assessed over the life of whatever prescription plan you would choose?
Jennifer Mullins 14:45
So how they do it is let’s say you do not select any plan at all. You just keep a and b. If you do not select a drug plan, you could have a penalty it’s 1% of the cost of the national average on a The drug plan. So let’s just say the plan costs $13 a month for a drug plan, it would be 1% penalty of that amount for every month that you didn’t have drug coverage. So they would add up the the months, and then they would have your amount and you would have to pay that for the rest of the time that you’re on Medicare.
Liz Craven 15:25
So it is optional, but it should not be optional. Go ahead and get the drug plan.
Jennifer Mullins 15:29
Yeah, if anything, if you’re not interested in any of the other options. The least you can do is just enroll in a drug plan to keep yourself because if you ever decide you do want to pick a different plan, you know, it’s important that you don’t get in that situation financially.
Liz Craven 15:46
So it sounds to me like it’s really important to find yourself some good education well before it’s time to sign up for Medicare.
Jennifer Mullins 15:55
Liz Craven 15:57
How would one go about doing that?
Jennifer Mullins 16:00
Some really helpful resources would be available at medicare.gov. You can actually go on to the medicare.gov website and order your Medicare and you Handbook, which they publish every single year. Each fall, there’s a new one that comes out. I would recommend having that book on hand because it really dives deep and answers a lot of those questions. You know choosing a Medigap policy, there’s a guide to health insurance for people with Medicare. It’s a publication developed jointly by CMS and National Association of insurance commissioners. So I definitely recommend going to medicare.gov and checking that out. I also recommend going to shiptacenter.org. It’s where you can view your State Health Insurance Program. There’s information on there as well. And then if you think you may qualify for any extra help, you’ll definitely want to make an appointment With your state Medicaid office, and also the Social Security Administration, because you may be able to get extra help to pay for your prescription drug premiums and your Medicare Part B premiums.
Liz Craven 17:12
Those are all terrific resources. And I’ll make sure that links to all of those that she just mentioned are available in both the blog post for this episode, which you can find at SageAging.us. And in the show notes, if you are listening from your podcast app, so be sure to check those show notes for easy links. So you don’t have to search all over the place to find those resources that she just mentioned. But I think it’s really important for people to really dig in and learn about what you’re doing because sometimes the choices that we’re making today, as we’ve just displayed through the prescription drug conversation, that can have consequences for a long time to come.
Jennifer Mullins 17:56
Yes, it can.
Liz Craven 17:57
Have you ever had people come in to you who are dealing with that? How are you able to find a workaround? If you can at all?
Jennifer Mullins 18:05
Yes. So that’s a great question. I think you have to ask the right questions. One question being Are you a veteran, you know, are you are you utilizing the VA for your prescription drugs? Next question, do you qualify for low income subsidy, which is in short, Li s, which is where Medicare will lower the cost of your drugs and it gets rid of that a penalty? You’ve got to ask the questions. And really, it’s having an agent on your side that can help ask those probing questions to see where they can get you the most help.
Liz Craven 18:40
You know, we’ve all heard that adage; You don’t know what you don’t know. And I think it certainly qualifies when it comes to Medicare because as a consumer, trying to figure out what the right questions to ask are, can be very difficult. And I think that most people are just at the mercy of whoever the person is. That’s sitting across from them. And though most people that I’ve run across tend to be really, really fantastic and know their stuff, and do their best to lead people in the right direction, sometimes choices are made just through sheer ignorance and just not knowing. So it’s important to make sure that who you’re talking to has a good reputation and what are some things that someone should look for when they’re looking for assistance with Medicare?
Jennifer Mullins 19:28
You know, you want someone that’s going to give you clear answers and help you navigate the inner workings of Medicare from your premium your co pays coinsurance is your deductibles, the network, you want to make sure that you have a clear understanding. And if you’re not sure, make sure to speak up and say, you know, I don’t understand. Can you explain that again? Because as an agent, our goal is to help you understand and to make you feel comfortable with your choice and to make you feel excited. And happy with your healthcare journey.
Liz Craven 20:03
Now, what about costs? Let’s talk about that for a moment. Because you hear all kinds of things in radio and television commercials about free premiums and let’s break it down. What does Medicare actually cost?
Jennifer Mullins 20:18
When you become eligible for Medicare, you do have a cost associated there is a Part B premium. That premium is $144.60. It comes out of your Social Security unless you’re paying it some other way, unless you set up a different form of payment. The only way to have that Part B premium zero cost to the beneficiary would be qualifying for Medicaid, which allows the state to pay the Part B premium,
Liz Craven 20:50
in which case Medicaid and Medicare would coexist and work hand in hand. Correct. Oh, the maze. The ins and outs.
Jennifer Mullins 21:01
It gets deeper and deeper.
Liz Craven 21:03
It really does. And that’s why it’s so important to have someone who understands this to help you. And I want to talk about for a minute, you mentioned it before SHIP, can you define that program because that’s something that’s available all over the country. Most of the time, I believe, maybe even all of the time that’s available through your local Area Agency on Aging, but it’s a program where volunteers can help you to work through what all of this means and and help you in deciding what the best choice is going to be for you. Can you talk a little bit about ship?
Jennifer Mullins 21:39
Yes, it’s a program that provides free health insurance information and counseling. It’s for people who aren’t sure you know, they want to have an unbiased opinion someone to sit down with them and kind of explain, I think it’s a good way to get ahead of the game. So that way, when you do sit down with an agent, you’re a little bit you know, you kind of have more information and more knowledge. Here in the area that I live in, in Lakeland, which is in Polk County, we have a program under SHIP called SHINE. It’s called Serving the Health Insurance Needs of Everyone. So it’s a great program to like I said, sit down, it doesn’t cost anything. And you’re really getting an unbiased opinion of all the plans.
Liz Craven 22:26
So in that instance, somebody would sit down with you and review basically what you have now what’s important to you and guide you to the right plan.
Jennifer Mullins 22:36
Liz Craven 22:38
Fantastic. Now, I’ll also provide links for the SHINE program in centralFlorida, and also how to find your own program wherever you live for the SHIP program. So all of those links are going to be available in the blog post and show notes as well.
Jennifer Mullins 22:56
One other thing that you want to consider Are when you sit down with whether it be an agent or with someone from the ship program. You want to consider these factors when making a Medicare choice. You want to consider your cost. How much will you pay for premiums, deductibles, coinsurance and co payments. Your benefits you want to look at? are additional benefits included such as prescription drug coverage. That’s important. convenience. are the plans in network providers conveniently located to your house? Are you going to need to drive far to go see your doctors? You want to look at your prescription needs. You know, have you needed care in the past for a few years? Do you anticipate your medicine needs will increase in providers? Do your doctors and preferred healthcare facilities accept the plan? So be sure before you meet with someone to have all these things listed out? So you know what’s most important to you? And you can consider all of these things before making your selection.
Liz Craven 24:04
Great advice. So to break that down, when you are ready to sit down with an agent or a ship volunteer, to start to dig through this, the things that you should bring with you would be a listing of your current medical providers, any ailments that you have any prescription drugs that you’re using. What else?
Jennifer Mullins 24:29
That sounds about, right? You mentioned your chronic conditions. Another good one is Will your healthcare needs grow in the near future? prescription drugs is important. You want to make sure your drugs are covered. So yeah, I think you hit them all.
Liz Craven 24:44
Very good. Well, I think that gives us a really good base to start from. But you know, I hope that everybody pays attention to this and takes the time to dig in a little bit deeper. We’re going to provide lots of links for you in the show notes. So this this episode, really is just to give you kind of an overview of what this whole Medicare thing means and how to get ready for it. But I know from assisting my mother and helping her, get her things ready, it was a lot of homework on our end to do the proper research and make sure that we were ready. So I hope that everybody will do that. And if you have specific questions about Medicare and need some answers, shoot those questions over to us at info@SageAging.us. And we will connect with Jennifer and others to make sure that we get good answers for you. And if you’d like to connect with Jennifer, we’ll have her info in the show notes as well so that you’re able to connect with her and ask her specific questions that might apply to your situation. So can you think of anything else that we’ve left out that we should be talking about?
I think you hit on everything Liz. Just if I can Just leave anything behind for anybody that’s out there, trying to go through the maze of Medicare. You know, find somebody that you connect with, find someone that you can trust that has your best interest at heart. Sometimes it’s more than health insurance. It’s finding somebody who truly cares about your needs.
Liz Craven 26:21
Those are very true words. And I think that applies in almost any situation, doesn’t it?
Jennifer Mullins 26:27
Yes, it does.
Liz Craven 26:29
Well, Jennifer, thank you for joining me today. I really appreciate you stopping by to share with us. I know that Medicare is not an easy topic to try to uncover in just 30 minutes, but I think you did a great job of covering the basics and giving us all a place to start from so we can dig a little deeper on our own. And thank all of you for listening in. I do really appreciate you taking a few minutes out of your day to spend with me. You’ll find a new episode every Tuesday morning in your playlist if you’re subscribed If you haven’t subscribed yet, I hope you’ll do that and I hope you’ll also take a minute to leave me a review. Next week we’ll be chatting with Laura banner of compassionate education. Laura is a neurology and dimension nurse practitioner and a dementia educator. If you have a loved one with dementia, you don’t want to miss that episode. It’s going to be really great. In the meantime, if you’ve got any feedback you’d like to share, we’d love to hear from you. info@SageAging.us Thanks, everybody, and we’ll talk to you next week.
Thanks for listening. If you found value in today’s conversation, I’d really appreciate it if you would leave a positive review and share the sage aging podcast with a friend. If you have topic ideas you’d like to share, we’d love to hear from you. Drop us a line at info@Sageaging.us
As I’ve been preparing to launch this podcast I’ve enjoyed revisiting stages of my own life and reflecting on how this topic became such a passion for me. While I’ve built my career on helping older adults and their families connect to needed education and resources, my connection to the aging and care process goes much deeper.
Some of my earliest childhood memories are of my own multi-generational family living together in one home. I was 4 or 5 when my grandmother moved into our home to help care for my sisters and I while our parents worked. Soon after, her father and grandfather moved in as well. We had 5 generations living under one roof! That was a beautifully chaotic adventure and knowing what I know now, I have so much respect for what my parents and grandmother did.
Fast forward to age 24. Newly married and pregnant with our first child, I spent several months with my in-laws to help care for my husband’s grandmother who had Alzheimer’s. Fast forward again to about 2009 – Wes and I have two teenagers about to head to college and his mother is diagnosed with cancer. Several years later, my mother is diagnosed with cancer. Several years after that Wes’ stepdad is diagnosed with Alzheimer’s disease and his father is suffering from severe dementia. You can see where this is going right? For the better part of the last 10 years we have been the caregivers. We see it as an honor and privilege to have been able to do that for our parents.
The key to navigating our later years is being proactive about gathering information before we get there and staying engaged once we do. To be sage is to be wise. There is wisdom in taking the time to ask questions, seek solutions and know your options before the need arises.
Each week we will discuss relevant topics of aging with experts who can help us to understand and be better prepared for aging. We’ll also introduce you to some Sage Agers who are totally owning their journeys through life. No topic will be off limits and we will deliver open and honest conversation meant to educate and empower our listeners. Each episode will also be available in video and blog formats.
Whether you are proactively seeking to broaden your own knowledge, a caregiver for a loved one or a professional working in the aging care industry, this podcast is for you. We hope you will join us as we explore and celebrate Sage Aging.