Medicare…….Ain’t nobody got time for that!!
Are you lucky enough to be a “Baby Boomer”? It is one of the fastest growing segments in history. And it is going to turn into a bigger topic as time goes on. 10,000 people a day are turning 65 for the next 19 years. Could that be why in almost every city you see Assisted Living, Nursing Homes, and Home Health Care companies on almost every corner? Easier to find than a Starbucks! This is actually a very positive improvement. About 30 years ago, when a person got older and needed assistance, the family had the choice of either sharing the responsibility or putting their loved one in a nursing home. Today, that would be a hard adjustment for most families because the children of the parents that need care are working full time jobs and taking care of their children and even grandchildren! They would really have to juggle things to have time to take care of their own parents. So many options now, first there is “in home health care” so they can stay in their home longer. There is “adult daycare” so someone can watch them while you are at work. Then there is “assisted” or “independent” living communities for safety and less work around a house. The higher level of care facilities would include “memory care” and “nursing home” which are usually wings that are provided in the independent living houses and they can just transition over as the need for care increases. If you haven’t ever toured a new Assisted Living community, you really need to. They just opened a new one across from Tulsa Hills called Legend Assisted Living. I attended the grand opening. It has a Bistro, a library, a theatre, a spa and sauna, a game room, a full restaurant, a hair salon, an in house Doctor and RN, and an activities director with a custom bus to take residents to appointments and to the store! It has sure come a long way since I was a child!
Okay, now let’s talk about MEDICARE! I say that 65 is the new 55! Almost every person I talk to that is turning 65 is still working a full time job! Remember when you were supposed to be “retired” at 65? Not any more……we are living longer and want to keep our minds very, very active. 65 year olds have adjusted to technology and were not left out of that huge change. We now rely on the baby boomers to teach the Millennials social skills! They are so used to using devices that they try to avoid personal conversations and contact. I digress, the direction I wanted to go was that people who are turning 65 are getting inundated with mail and phone calls from insurance companies 3 months before their 65th birthday. They also receive a huge catalog from Medicare for them to read in their leisure time ( yeah right) that is written by someone who probably sits in a room with no windows! Not a lot of direction for them, just read, get on the internet, or go to an insurance meeting to figure it out! They have 3 months before their 65th birthday, the month of, and 3 months after to make a decision. This is called “open enrollment”. It will only happen once in our lifetime, so you better make a good decision. Also, just to lay it out there, there could be a chance that if you become unhealthy, you may be stuck on the plan you decided to go with. That is the part they really don’t tell you!
Don’t laugh, but Medicare is not that difficult. There is Part A, which is Hospitalization. Part B, which is the Doctor’s part. Medicare pays 80%, and has deductibles. A person turning 65 needs to know the difference between a Part C, or Medicare Advantage, and a Medicare Supplement, which would include the letters F,G,K,L,M,N. The part D drug plan can be included the Medicare Advantage plans, but doesn’t have to be if you have other creditable ways to get your prescriptions like the VA or the Indian Clinics. Medicare Advantage plans in this area are going to include but not limited to Community Care and Humana. These are plans that have “networks” so you will have to have a primary care physician, he will handle your referrals and these plans are offered based on you being in Oklahoma and what is your zip code. If you do not use their “network”, the expenses will not be covered. You can choose different plans based on what you want to pay in premium. But remember, you are either going to pay now, or pay later. So if you have a low or no premium, if you are hospitalized or have a bad accident, you will have big co-pays and deductibles. You can change within the Advantage plans offered once a year after you go on at 65, and that is during “general enrollment” which starts in October for a January effective date. If you attend one of their meetings about their plans, they will not tell you about the Medicare Supplements, unless they are a company who offers both. So do some research about Medicare Supplements as well. The F plan and the G plan are the two I recommend. They are the most comprehensive. The “F” plan has no network, no primary care physician, no co-pays, no deductibles and you can travel or move anywhere in the United States and get the care you need and not have to change. If it is a Medicare covered expense, the “F” plan will cover the rest. This would be a good plan to have if someone had a serious illness and wanted to use any specialist they wanted. Also, if you are on a “Supplement” you do not have to enroll every year, but you can shop it with other companies to see if you can get a better rate as long as you are healthy. Once again, a part D drug plan would also have to be added. If a person turns 65 and does not have a creditable drug plan, a penalty will start to accrue until you enroll in one. So, even if you don’t take any drugs now, be sure to get a basic drug plan to avoid the penalty. These drug plans also need to be shopped every year during general enrollment ( starting in October for January effective date) because rates change and drugs change tier levels.
Let’s go back to the 65 year old still working! So, if you are lucky enough to work for a company who pays for your health insurance, if it doesn’t have a huge deductible, you may want to stay with that group insurance as your primary. You will automatically get part A, but it doesn’t cost you anything. You would just need to make sure you do not enroll in Part B. This part of Medicare does cost you! It would also turn Medicare into your primary plan. You don’t need both group health and Medicare. If you are still working and not drawing Social Security, you may not even get a Medicare card in the mail. But trust me, you will get lots of sales material from every insurance company out there! When you do decide to retire, that is when you will need to apply for part B. This will open up a “Special Enrollment” anytime during the year and you will need to make your Part B effective date the first of the month after your group insurance ends. You will have a little window there where you will have to decide then whether you want an Advantage Plan or a Supplement like I discussed above. When you are ready to make that decision, whether Open Enrollment or Special Enrollment, it is best to talk to a “Broker” if you can. They are not tied to just offering one product because brokers represent many companies.
I would also like to get some information out to any retired Teachers in Oklahoma. During their active teaching years, they are covered through the State of Oklahoma. When a teacher turns 65, they have the same options listed above. The Teachers’ Retirement System will turn their group coverage into a Medicare plan if they stay with them. My advice would be for any retired teacher to call and ask what plan they are enrolled in, a supplement or an advantage plan and how much is being held out of their retirement check. The State does give you some money towards your premium so deduct that out. When you have the amount, you can shop the rates of that plan and see the difference. I think they will be surprised! I have worked with several retired teachers and was able to save them a lot of money! Don’t just be comfortable with what you have always had.
Just a little about myself, I have been an insurance agent in Oklahoma for 28 years. I am a graduate of Sapulpa High School. I am a Broker and specialize in Medicare. I worked with Teachers in Oklahoma and their benefits for 20 years. I have an office in Tulsa, with a local number of 918-938-5001. I love taking care of people and pride myself in very special customer service! I put my cell phone number on my business cards. I want my clients to call me, not a 1-800 number!