Confusing aspects of Medicare Insurance

Presenter: Neal
Guest: Danielle Kunkle
Guest Bio: Danielle Kunkle is the co-owner of Boomer Benefits, an agency that specializes in Medicare-related insurance products nationwide. She is the immediate past-president of the Fort Worth Association of Health Underwriters and currently sits on the board of the state association as its quarterly magazine editor.
Segment Overview: Danielle Kunkle discusses some of the most confusing aspects of Medicare Insurance….Medicare Part “D”.


HPR – Health Professional Radio

Neal: Hello and welcome to Health Professional Radio. I’m your host, Neal Howard. So glad that you decided to join us today. Medicare is one of the most confusing aspects of turning 65. Baby boomers are fast approaching that age and we are looking for options when it comes to insurance once we either supplement it with Medicare or totally get off of our company’s insurance. Our guest in studio today is Danielle Kunkle, Medicare insurance expert, author and speaker and she’s here with us today to give some insight into understanding this confusing aspect of healthcare. How are you doing today, Danielle?

Danielle: I’m terrific, how are you?

N: I’m doing well. Glad that you decided to return with us and give us a little more insight into your area of expertise and also into Medicare as a whole. When you were here before, we were talking about the many different parts of the Medicare healthcare program. One of the most talked about parts of Medicare is the part D, you talked about a doughnut hole as being something to avoid, could you explain to us what is the Medicare part D doughnut hole and why is it so important that we avoid it?

D: The doughnut hole is a piece of the year after which you have spent a certain amount of money when your co-insurance that you pay for the cost of your prescription can go up. So when Medicare first created part D, they were trying to figure out how to provide prescription drug coverage for the majority of Medicare beneficiaries in America but they also needed to encourage those beneficiaries to consider generic drugs and inexpensive drugs as a means to keep the Medicare cost down as a whole. And so what happens with your part D is every time you go with a prescription, your insurance company tracks for Medicare how much you have spent on prescription drugs and across all part D drug plans in the nation when you a reach a certain limit at that point, you go into what is called the coverage gap and commonly called by consumers – the doughnut hole.

A few years ago, when you reach the donut hole you would pay a hundred of the cost of your medication during that coverage gap and so you might have been paying $40 for prescription and then when you past that threshold, now all of a sudden you’re paying a hundred. And the affordable care act legislation actually revised that much for the better for consumers, now when you go into the doughnut hole, you’ll pay 45% of the cost of your prescription drugs and your carrier picks up the rest. However, if you have a drug that costs, say $300 a month, you’re going to have, still a piece that you’re gonna need to cover and so one of the things that consumers can do is review their medications online using Medicare’s website. Medicare’s website has a prescription drug finder tool where you can punch in your prescription and your dosage and frequency and you can see exactly how much each drug is contributing towards your annual total and then you take that information to your physician and be able to point out which drugs are putting you close to the doughnut hole each year. And then maybe the physician can work with you on small alternative that would keep you out of that doughnut hole for as long as possible.

N: Could you describe for us maybe a couple of alternatives that a healthcare professional might offer to one of his patients?

D: Sure! Of course we have your standard generics, so anytime there’s a prescription out there that goes off its patent and they can offer the generic – that is great. And sometimes we find that physicians may not always be thinking, “Oh I’ve got a person here on Medicare, I should really not write the brand name prescription, let’s go ahead and try the generic and see if that works.” And so if you’re proactively thinking about “hey this client have a doughnut hole to pay. Am I prescribing a brand name medication where I could be”, letting them know to try generic, that’s gonna be something that’ll really help your patients. Also, Medicare  part D drug plans – they have to offer at least 2 medications in each therapeutic class, so whatever condition that this medication that you may be prescribing is gonna treat for your patient is there happens to be an alternative drug that also treats the same condition, that does have a generic alternative. That is another way just helping them explore what some of the other medications might be that they can try so in some condition we have scores of different medications for them, being blood pressure, being an easy one to think about and lots of generic drugs that we can try. So if you try those with your patient and that works for them, you’re gonna help them avoid the doughnut hole. In some cases, brand name medications are really the ones that they need to stick with and if you have a good reason for not working with the generic or not accepting the generic as readily then explain to your patients so they know that may be this is really worse ever happened than a little more during the year because my physician truly believes that this brand name medication, this specific medication is gonna treat my condition better.

N: Now, we’ve been talking about percentages, we’ve been talking about manipulating, well not manipulating the number, but keeping track of the numbers and consulting with your doctor in order to better understand where you stand with Medicare. Now, when it comes down to the bottom line, how much does Medicare cost?

D: Medicare has a lot of unexpected costs that people don’t think about, when you’re working throughout your working lifetime, you pay a tax on your every payroll and that goes toward paying your Medicare part A which is your hospital insurance  and those people by the time they reach age 65 have either worked 10 years in the United States- forty quarters is the number they’re trying to hit or at then married to someone that has – and so lot of times they don’t pay for part A but because of tax comes on every your pay check on you always on there throughout your working lifetime, there’s a public perception that Medicare is paid up for already paid for and so it can be a surprise to people when turn 65 and realize that the other part which is your out-patient insurance covering all the things that we think about as normal healthcare benefits, doctors does it, surgeries, lab works, part B, you actually have to a premium for, currently, that number is a hundred and four dollars and ninety cents. In America, it can be higher based on your income. So you wanna be prepared just for your basic Medicare to know that you’re gonna go into that at least spending around a hundred and five dollars.

N: Now, you’re the co-founder of Boomer Benefits, it’s an insurance agency that’s specializes in Medicare plans. Now, you also teach the 8-hour Medicare related products certification course that insurance agency in the state of Texas they must have this in order to work with Medicare insurance products, when it comes to your healthcare provider, do you teach staff about the intricacies of Medicare so that the nurses and techs and even the healthcare provider, this probably gonna be only gonna be able to see you for about 8 minutes at the max, do you teach them methods by which they can transmit this information in a timely and understandable fashion to the patient that come in?

D: Absolutely! We do. We first started working with Medicare products many years ago, we actually did a lot of face to face, walking in the doctor’s offices, explaining who we were, giving our information out so that they can call and we found over time that a lot of the staff in doctor’s offices are just as confused about some of the Medicare mysteries as the public are. So we have gone out locally here, we’ve met with some doctor’s offices and have done lunches and learn and explaining different Medicare products, we’ve also had a few that we worked with that will give business cards so that maybe they don’t have time to train their own staff but they wanna send patient over to us and have that patient get educated while also knowing which doctor sent that person to us so that we can notify the patient, “Hey if you wanna continue seeing this doctor, he participates in Medicare, so all the Medigap plans will work and then here’s also some other plans he participates in”. Medicare does have some requirements about making sure you’re fair with the information but mostly, we find the doctor’s offices, they just want their patients to have that. And so, even in areas where our agency is active in forty states but even areas where we don’t get together face to face, we can do conference calls with the doctor’s office’s office managers and answer questions and also just be a resource for them when someone brings in a question they don’t know the answer to.

N: As we wrap up this segment, I’d like to ask you a question. In your experience, I’m sure you speak with the healthcare professionals on a regular basis and maybe you’ve noticed some healthcare professionals moving away from their practice based on the confusing affordable care act, not wanting to have to learn new procedures, not wanting to have to understand the insurance, not wanting to have to comply by next year with certain aspects of the affordable healthcare act, do you find the same resistance or apprehension when dealing with healthcare professionals with Medicare and that education?

D: We do find some, it seems like the healthcare providers are a little more open to working with Medicare because it’s been around longer, it’s not the new kid on the block that we have to learn so many new things about. One area we do see some changes happening with Medicare is of course that physicians need to be compensated for their time and training and all the other things that cost their run on medical practice, and we find that Medicare course is not the highest compensation, and so lots of doctors especially family practice doctors, their patient-mix can only be made up of so many Medicare-age individual because they get compensated more highly for people that have employer-group insurance in a younger time in their life, so Medicare is not quite as confusing but I do think that probably every year healthcare providers have to evaluate how many people they can see with Medicare so that they can have a practice that flourish.

N: So basically, you have to, as a healthcare provider you have to be careful as to the number of Medicare patients that you have known based on your own compensation as a provider, yeah?

D: We do, we find a lot of them. Definitely, look at that and are concerned about that.

N: Some absolutely wonderful information. Our guest in studio today has been Danielle Kunkle, Medicare insurance expert, author and speaker. You’ve been listening to Health Professional Radio. I’m your host Neal Howard. And we’ve been here talking about some of the ways that consumers and healthcare professionals like and begin to learn to understand the confusing world of Medicare. It’s been great having you here with us today, Danielle.

D: I appreciate you having me, thank you so much.

N: Thank you. Audio of this program is available at and also at HPR.FM and you can subscribe to our podcast on iTunes.

Liked it? Take a second to support healthprofessionalradio on Patreon!