Hidden costs associated with Medicare

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 hidden costs associated with Medicare.


HPR – Health Professional Radio

Neal: Hello, you’re listening to Health Professional Radio. I’m your host, Neal Howard. Thank you so much for joining us today. Medicare is a confusing aspect of healthcare. As confusing, many think as the Affordable Care Act. Our guest in studio today is Danielle Kunkle, a Medicare insurance expert, author and speaker and co-founder of Boomer Benefits – an insurance agency that specializes in Medicare plans and she’s here today to explain the intricacies of Medicare and hopefully our health professionals can show us a little bit of care and understanding when we come in confused about this aspect of healthcare. How are you doing today Danielle?

Danielle:  I’m terrific. How are you?

N: I’m doing well, thank you for joining us today. Many of our healthcare professionals are as confused about Medicare – the different parts – as their patients. Many times when they come in, the healthcare professional is hoping that they’ve got it all together, they know exactly what they want, they know which drugs they want, they know where they stand with Medicare but that normally is not the case. Your company helps people to understand Medicare much better and also to make some informed decisions as it were. Now, as we are talking about these decisions, usually, it’s about follow the money. Your sixty five, you’ve made a lot of decisions in your life, maybe some investments. You may be retiring and losing your company benefits. What kinds of insurance choices exist for people with limited budget when it comes to Medicare?

D: One great thing about Medicare Insurance is there really is something for everybody in terms of budget. For many years, we had people just having original Medicare and they could add on a MediGap policy and those policies are very thorough, do cost more and people do live on fixed income and retirement so those options sometimes would limit people for being able to afford a supplement and you definitely need some sort of insurance because one thing about Medicare on part B or outpatient coverage, it only covers eighty percent and there is no cap on the twenty percent that you pay. So if you have something expensive like a surgery, you can really find yourself owing quite a lot of money. Well what happened some years ago as part of the Balanced Budget Act is we created what is now called today Medicare Advantage Plans, and these plans are private Medicare plans, typically coordinated care networks like an HMO or PPO and these plans offer people on Medicare an opportunity to pay a lower premium and then pay as they go for their Medicare services in forms of co-pay and co-insurance so instead of the bills the provider send going straight to Medicare and then the MediGap company picks up the difference, you will actually have your provider send their bills to the Medicare Advantage Plan that you joined and then you pay the co-pay applicable for the service that your receiving. So for instance, you might be on a Medicare Advantage Plan and you could find one that would have a doctor co-pay for your primary care doctor of five dollars. Maybe you go see a specialist and it’s twenty five or thirty or forty, and so this is a way that some people who perhaps could not afford a hundred and fifty dollars a month for a supplement, can join a plan which in some circumstances could have premiums as low as zero …

N: Zero?

D: and just pay for their services that they go along.

N: Okay so you are talking about a Medicare plans that actually free?

D: Yeah, that is a common misconception I guess. You’re right from the consumer’s perspective, it would be free. From the Medicare Advantage Plan’s perspective, they actually got compensated by Medicare for your enrollment so they say to Medicare, “Hey, we’re taking all of the risks for this person under our company this year. They’ve enrolled and were gonna take care all of their bills.” And so then Medicare pay them a fee every month to roll their health insurance out and so even though it’s technically not free because the Medicare is still paying the Medicare Advantage company to the consumer. It’s a zero premium which can be so nice when we’re living on just, you know, social security income in some cases.

N: The Medicare annual election period, is that the same as this doughnut as we talked other segments or is that a totally different thing?

D: Totally different. So the annual election period comes on every year on the fall and it’s from October 15th to December 7Th …

N: Oh it’s about this time.

D: Yes, that’s right. And this is the time when people can join a Medicare Advantage Plan or they could leave a Medicare Advantage Plan and go back to original Medicare. They can also enroll in a stand-alone drug plan so if you have Medicare or Medicare as a supplement, you need to have prescriptions covered you can also enroll in a Part D drug plan and the great thing about the election period is that with Part D drug plan, there is no help underrating. Everyone is entitled on Medicare to enroll on a plan so you can always join a stand-alone drug plan during the annual election period and those benefits will start on January 1st. And so that’s why this is such a big important period in the annual cycle with Medicare because you might be on a drug plan and perhaps you had a new medication and the drug is not covered on that formulary or maybe you did not have insurance before and now you have some prescription needs so you want to join. You have the opportunity to do that every fall.

N: If there exists a situation where you have insurance for whatever reason, may be you left the company and you get to keep your insurance or a part of your insurance and you’re considering Medicare -are there situations where you have half and half normally or is that normally not the case and are there situations where you just forgo Medicare all together?

D: There could be. There’s a lot of companies out there that have retirement insurance packages and so for people that have retired from a company, if they’re offered a company benefit plan, that plan can actually coordinate with your Medicare and Medicare will step in to limit some of the exposure that you have by kicking in certain payments that coordinate with your group plan. And in some cases also, we have people that are actively working these days, long past age sixty five, those people also have the opportunity to stay with their group insurance and they can choose whether or not they would like to enroll in Medicare and have those benefits coordinated. And the benefit to them of doing that would be, for instance, if you have an employer group plan with the five thousand dollar deductible – Medicare is deductible for hospital is twelve hundred and sixteen currently, so when a person might go and have a hospital stay and normally they would have to pay the whole five thousand dollars if you’re in the hospital for a couple of days. You would hit your deductible on your health plan. Medicare would actually pop in and cover from twelve hundred sixteen up to five thousand so that you are only exposed to the twelve hundred and sixteen dollars for your hospital deductible on Medicare. And so it could be a great thing to have Medicare working alongside your group insurance.

N: Now as we wrap up this segment Danielle, many people are, well, they’re intimidated, when they talk to their doctor. They don’t want to seem like they don’t know what is going on. They sit and maybe let the doctor make all the decisions and tell them what they’re gonna do without a lot of input because they’ve been brought up to respect authority or, “The doctor’s the smart one. I’ll just sit back and take his advice.” How can a doctor and his staff, his or her staff, show care and concern and let them know that, “Hey, it’s okay to talk to me about this extremely confusing aspect of your healthcare.”

D: I think that is really a great question, and I think its takes a total clinic approach from the doctor’s office to educating himself or herself and also the staff in the office. Maybe just having them understand the types of insurance available so that if the doctor or nurse is meeting with someone and they know that somebody has, let’ say, original Medicare and a very full coverage supplement, they’re goanna know then that, “Hey, this person’s insurance is really full coverage. They’re gonna be able to afford this procedure. I can talk to them about this.” If they happen to see that someone is on the Medicare Advantage Plan and know then would be aware enough to know what kind of co-pays may go alongside certain recommended procedures, that’s a way to be sensitive. You know, if you’re recommending a type of surgery and a person has a plan where that surgery co-pay is three hundred dollars, you could be sensitive to that by just understanding a little bit about their insurance. And if these clinics, of course, the healthcare providers are so busy – if they don’t have time to inform the patient about themselves, then pairing them up with a knowledgeable person in the consumer world such as an insurance agent that specializes in that you can at least have someone or send them to that at for that information and just helping your patients get the basics is so appreciated because that’s the part they’re most confused about. They don’t understand what they’re gonna be responsible for. So if the staff knows what that’s going to be or can refer them to someone that can tell them what that’s going to be, they will be able to make educated decisions about what procedures they’re okay with and they can afford as opposed to ones that they really cannot.

Neil: Now where can healthcare providers and consumers alike go online to find more information about your agency?

Danielle: You can find us online at www.boomer.benefits.com We have hundreds of pages and information about Medicare, several different pages that explain Medicare for people that are new to Medicare. There are links on there for video information and also podcasts like this one where you can learn about Medicare if you listen or learn better in an audio fashion. Also, you’re certainly welcome to contact our agency and ask those questions. Our Toll Free number 1866-452-8686 and we have a team of licensed agents here that can help educate you about your Medicare and then assist you with questions about insurance.

Neal: You’ve been listening to Health Professional Radio. I’m your host, Neal Howard. It’s been an absolute pleasure having you in studio here today, Danielle Kunkle – Medicare insurance expert, author and speaker and teacher of the Eight-Hour Medicare Related Products Certification. It’s been great having you here with us today.

Danielle: Thank you so much. I’m glad to be here.

Neal: Thank you. Audio of this program is available at hpr.fm also at healthprofessionalradio.com.au and you can subscribe to our podcast on iTunes.


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