[00:00:05]
EVERYBODY CAN SEE THAT, RIGHT? YEAH.
UM, I'M AN ADVOCATE, UM, AND I PROVIDE INFORMATION AND SUPPORT, UH, IN REGARDS TO MEDICARE FOR OUR SENIOR, UH, COMMUNITY, AND NOT JUST HERE, BUT IN OTHER PARTS OF WESTCHESTER.
UM, MY GOAL IS REALLY TO PROVIDE INFORMATION.
I KNOW IT CAN BE VERY CONFUSING.
I WAS TOLD THAT A LOT OF YOU ALREADY HAVE MEDICARE.
I'M JUST GONNA REVIEW QUICKLY WHAT IT IS, AND THEN WE'LL GO AND DO OUR SIP AND PAINT.
UH, I SPECIALIZE IN MEDICARE, UH, ADVANTAGE PLANS.
SO IF ANY OF YOU HAVE, UH, ANY QUESTIONS, IF YOU WANNA CHANGE PLANS, UM, ANYTHING IN GENERAL, I CAN HELP YOU WITH THAT.
UM, WE ALSO HAVE COLLABORATION WITH OTHER, UH, INDIVIDUALS WHO CAN, UH, PROVIDE OTHER INFORMATION REGARD REGARDING OTHER RESOURCES LIKE MEDICAID APPLICATION, UM, AND, UH, OTHER ACCOUNTS THAT MIGHT BE LIKE SAVINGS ACCOUNTS THAT YOU MIGHT BE INTERESTED IN.
IF YOU HAVE ANY QUESTIONS OR ANY POINT, YOU CAN LET ME KNOW.
AGAIN, AS I WAS TOLD THAT YOU, MOST OF YOU HAVE MEDICARE.
I'M GONNA TRY TO JUST GO FAST AND THEN GET RIGHT TO THE SIP AND PAIN, BUT AGAIN, I'LL BE HERE AS A RESOURCE.
YEAH, THAT'S, THAT'S ONE OF THE A SLA LS.
I'M SORRY, BUT NOW I KNOW BECAUSE OF THAT DISEASE DO NOT COVER.
AND IT SHOULD, BUT THERE'S A LOT OF, I THINK DISEASES ESPECIALLY LIKE CHRONIC BLOOD PRESSURE, HIGH BLOOD, PRE CHRONIC, HIGH BLOOD PRESSURE BECAUSE IT'S A LIFE THREATENING, UH, DISEASE THAT SHOULD BE ALSO, UH, ELIGIBLE, BUT IT'S NOT.
THERE ARE OTHER DISEASES THAT SHOULD BE ABLE TO QUALIFY.
ANOTHER THING IS THAT IF AN INDIVIDUAL HAS BEEN IN A SOCIAL SECURITY DISABILITY INCOME FOR MORE THAN TWO YEARS, THEY'RE ALSO ELIGIBLE.
SO LET'S SAY I HAVE A, A CLIENT WHO IS 45 YEARS OLD AND SHE'S BEEN ON SOCIAL SECURITY DISABILITY INCOME FOR ABOUT THREE YEARS.
AND THAT CAN BE ALSO, THAT'S SORT OF A DIFFERENT CATEGORY NOW FOR SOCIAL SECURITY DISABILITY INCOME.
IT INCLUDES MENTAL HEALTH, DRUG ADDICTION, OTHER THINGS.
SO THAT'S ANOTHER, UH, SORT OF, UM, QUALIFICATION CRITERIA THAT A LOT OF PEOPLE MIGHT NOT NECESSARILY BE AWARE OF.
SO ANYBODY THAT HAS SDI TO YOU, FIVE, THEY'RE FOR MEDICARE.
DOES IT MATTER YOUR INCOME? SO THAT'S A GOOD QUESTION BECAUSE IT VARIES.
IT CAN HAVE THE INCOME, BUT THERE'S ALSO THE INCOME PLUS.
SO DEPENDING ON THE DISABILITY, YOU CAN STILL QUALIFY.
IT DOESN'T NECESSARILY MEAN THAT BECAUSE YOU'RE HIGH INCOME, YOU NECESSARILY ARE NOT ELIGIBLE.
SO, UM, SO WHAT IS MEDICARE? AND AGAIN, A LOT OF YOU MAY KNOW, UH, IT'S A FEDERAL HEALTH INSURANCE PROGRAM FOR PEOPLE 65 YEARS AND OLDER AND OR PEOPLE WHO HAVE CERTAIN DISABILITIES, AS WE JUST MENTIONED, AND WHO QUALIFIES AGAIN, UH, US CITIZENS.
AND YOU HAVE TO HAVE, UH, 10 WORK, 10 YEARS OF WORK HISTORY OR 40 QUARTERS.
NOW, WE CAN ALSO, UM, GET MEDICARE IF WE DON'T HAVE THOSE 40 QUARTERS.
AND NOW ALSO IF YOU'RE NOT A US CITIZEN, BUT IF YOU'VE BEEN A RESIDENT, A LEGAL RESIDENT FOR FIVE YEARS, YOU CAN ALSO QUALIFY FOR MEDICARE.
SO THERE'S CERTAIN THINGS GET INFORMATION, UM, THAT UM, THAT IT'S IMPORTANT TO KNOW.
AND WHAT IS, I'M SORRY, GO AHEAD.
NEUROMUSCULAR DISEASE, PARDON? OTHER TYPES OF NEUROMUSCULAR DISEASES, ARE THEY COVERED AS WELL? SO AGAIN, THAT WOULD BE SOMETHING THAT YOUR DOCTOR, IT, YOU KNOW, WE, WE, UH, REACH OUT TO THE DOCTORS AND THE DOCTORS.
IF THEY GIVE YOU THAT DISABILITY CRITERIA, YOU CAN DEFINITELY BE AALS A YES.
S UM, OKAY, SO THE AUDI, ORIGINALLY MED ORIGINAL MEDICARE, AS WE KNOW IT WAS PART A AND B AND THE PART A COVERS
[00:05:01]
HOSPITAL.NOW INPATIENT ALSO A HOSPITAL AND SKILLED, UH, NURSING HOME HEALTH CARE AND HOSPICE CARE.
PART B PROVIDES COVERAGE FOR DOCTOR VISITS, LABS, X-RAY OUTPATIENT SERVICES AND MEDICAL EQUIPMENT WHEELCHAIRS.
UH, ALSO CHAIRS THAT SUPPORT WHEN WE HAVE TO, YOU KNOW, GO IN THE, IN THE BATHROOM IN THE TUB TO SHOWER IN A VERY SAFE, SECURE MANNER.
NOW, A AND B ARE WHAT WE CALL ORIGINAL MEDICARE.
WE ALSO HAVE, AS I MENTIONED BEFORE, AND THE PART A, IF YOU DON'T HAVE, IF YOU HAVE THOSE 10 YEAR HISTORY, THERE'S ZERO COPAY.
HOWEVER, IF YOU DON'T LIKE, WE HAVE INDEPENDENT CONTRACTORS OR PEOPLE WHO'VE WORKED PART-TIME FOR A CERTAIN AMOUNT OF TIME.
THERE ARE CER CERTAIN, UM, DEDUCTIONS, LET'S SAY, OR PAYMENTS.
SO IF IT'S 30 TO 39 QUARTERS, THE PAY, THE PAYMENT IS $310 PER MONTH.
IF IT'S LESS THAN 30 QUARTERS, IT'S $518 PER MONTH.
MEDICARE PART B IS, DOES REQUIRE ALSO A PREMIUM.
EXCUSE ME, THIS YEAR IT'S 185.
IT WENT DOWN 'CAUSE LAST YEAR IT WAS 206.
UM, AND MOST OF THE TIME ISS DEDUCTED FROM YOUR SOCIAL SECURITY CHECK.
IF YOU GET A DISABILITY, IT'LL BE DEDUCTED FROM THE DISABILITY.
HOWEVER, IF YOU DO HAVE MEDICAID, WE CAN PAIR THEM UP AND MEDICAID CAN COVER BOTH A AND B.
SO THAT'S ANOTHER, UH, INFORMATION THAT IT'S USEFUL TO HAVE.
PARDON? START FOR PART A OR B.
IT WAS, IT WENT DOWN TO 180 5 AND 2, 2 0 6.
UM, SO WHEN IT COMES TO MEDICAID, ALSO IT WAS INCREASED THE INCOME ELIGIBILITY.
SO NOW IF, UH, YOU MAKE 60 16,000 ANNUALLY YOU ARE, UM, ELIGIBLE FOR MEDICAID AND OR, UH, BELOW 21,600 FOR ONE PERSON.
NOW, I KNOW SOMETIMES WITH OUR PARTNERS OR HUSBANDS AND WIVES, AS WE APPLY TOGETHER, WE MIGHT GO OVER INCOME.
SO SOMETIMES WE RECOMMEND YOU APPLY AS AN INDIVIDUAL INSTEAD OF AS A COUPLE.
BUT THOSE ARE LITTLE THINGS AGAIN THAT WE RECOMMEND DEPENDING ON EVERY CASE, DIFFERENT CASE.
UM, AND SO AGAIN, WHEN YOU HAVE MEDICAID, YOU CAN, UH, BE ELIGIBLE FOR OTHER PROGRAMS THAT WILL HELP YOU PAY FOR, UM, THOSE PART A AND B PREMIUM.
SO TO GIVE YOU AN EXAMPLE, I ENROLLED, UM, A LADY WHO IS SE 73.
SHE'S BEEN IN THE COUNTRY FOR, I DON'T KNOW, 20 YEARS.
SHE NEVER KNEW ABOUT MEDICARE.
UH, BUT SHE HAD NEVER WORKED HERE AND SHE HAD HIGH PRESSURE.
WELL, SHE HAS HIGH BLOOD ION AND OTHER, UH, DIFFICULTIES.
HOWEVER, BECAUSE SHE GETS MEDICAID FOR ALL THESE, UM, CHRONIC DISEASES, SHE WAS, SHE DOESN'T PAY A DIME FOR PART A AND PART B, ALTHOUGH SHE'S NEVER WORKED HERE.
SO THAT'S, THAT'S GOOD INFORMATION TO HAVE.
THERE'S WAYS, AGAIN, TO GO AROUND NOT BEING ABLE TO, OR NOT, OR FOR THE, FOR THE STATE NOT TO TAKE THAT MONEY FROM IT BECAUSE THE COST OF LIVING REALLY IS HIGH.
AND WHEN YOU ADD UP PART A AND PART B, IT CAN REALLY BE SIGNIFICANT.
SO THAT'S THE M WHAT WE CALL THE MSP.
AND UH, NOW ALSO FOR PRESCRIPTION, IF YOU HAVE TO PAY OUT OF POCKET, THE MAXIMUM IS 2,100 PER YEAR.
OKAY? UH, THERE'S ALSO MONTHLY PAYMENT PLANS THAT YOU CAN, UH, SPEAK TO YOUR PHARMACY AND YOU CAN SAY, HEY, I DON'T HAVE, I'M MAKING IT UP A THOUSAND DOLLARS TO PAY FOR THIS PRESCRIPTION.
CAN YOU SPREAD IT OUT OVER THE MONTH? RIGHT.
AND THEY, THEY SHOULD BE ABLE TO DO THAT.
UM, AND THEN WE HAVE MEDICARE PART C.
AND THIS IS WHERE IT CAN BE A LITTLE BIT CONFUSING.
WE CALL THOSE MEDICARE ADVANTAGE PLANS.
AND A LOT OF IT IS PROVIDED BY PRIVATE HEALTH INSURANCE, AETNA HEALTH FIRST VNS,
[00:10:02]
UM, UH, UNITED WELLCARE, ET CETERA.AND THOSE IN REPLACE OR TAKE OVER PART A AND B.
BUT YOU MUST HAVE PART A AND B TO GET C.
BUT ONCE YOU HAVE A AND B, YOU CAN GET C AND C WILL COVER ALL THOSE HOSPITAL STAYS, PRESCRIPTION EVERYTHING.
UM, AND SO THERE, THERE'S SORT OF A BUNDLE, RIGHT? YOU GET A, B AND D.
THERE'S THE HMO AND THERE THERE'S THE PPO.
SO WHAT'S THE DIFFERENCE? SO HMO, YOU HAVE TO GO TO A DOCTOR IS IN THE NETWORK AND YOU HAVE TO, UM, USE ONLY THE ONES THAT ARE IN NETWORK.
IF YOU GO OUT OF NETWORK IS NOT COVERED.
BUT IF YOU SAY, YOU KNOW, I DON'T WANNA GO TO THESE DOCTORS, I WANNA BE ABLE TO GO TO ANY DOCTOR I WANT, YOU CAN CHOOSE A PPO PLAN AND THEN YOU CAN GO TO OUT OF NETWORK AS WELL.
THAT'S WHAT THEY CALL SUPPLEMENTAL ADVANTAGE PLAN.
SO IT'S IT LIKE IT'S COVERS, IT TAKES, IT BUNDLES UP THE A, B AND CI MEAN AND D.
BUT WHAT IT DOES IS THAT INSTEAD OF, LET'S SAY WHEN YOU HAVE ORIGINAL MEDICARE, IF YOU HAVE PART A AND B, IT DOESN'T FULLY COVER, RIGHT? THAT'S 20%.
SO WHEN YOU HAVE A AND B, YOU HAVE TO PAY 20%.
SO LET'S SAY YOU GO TO THE DOCTOR AND YOU ONLY HAVE ORIGINAL MEDICARE AND YOU DON'T HAVE PART C AND YOUR BILL CAME UP TO A THOUSAND DOLLARS.
SO MEDIC ORIGINAL MEDICARE AB PAYS 80%.
YOU ARE RESPONSIBLE FOR THE OTHER 200, BUT NOT WHEN YOU HAVE C.
SO THAT'S WHY IT'S CALLED ADVANTAGE A AND D FOR DRUGS.
YOU CAN, I GUESS YOU CAN SAY SUPPLEMENTAL BECAUSE, BUT IT REALLY IS AN ADVANTAGE BECAUSE YOU ARE SORT OF BUNDLING UP A, THE COVERAGE FOR HOSPITAL AND THE DOCTOR AND THE DRUGS THAT IN ORIGINAL MEDICARE IT'S SEPARATE.
A IS FOR ONE THING, B IS FOR ANOTHER THING AND D IS FOR ANOTHER THING.
WHEN YOU HAVE C, YOU JUST NEED ONE CARD TO GO EVERYWHERE.
TO GO TO YOUR PHARMACY, TO YOUR DOCTOR, TO THE HOSPITAL.
BUT IF YOU HAVE AN ILLNESS, THEY HAVE TO APPROVE IT RIGHT BEFORE THEY REIMBURSED.
THAT'S WHY THERE'S SEVERAL PLANS IN EVERY PLAN.
LIKE LET'S SAY I AM GONNA, YOU KNOW, YOU TELL ME YELLA, I'M LOOKING FOR, I HAD A CLIENT WHO WAS LOOKING FOR HEARING AIDS.
THE HEARING AIDS WERE NOT BEING COVERED BY ONE PLAN.
WE LOOKED AT OTHER PLAN AND IT COVERED A HUNDRED PERCENT BECAUSE DIFFERENT PLANS OFFER DIFFERENT THINGS.
JUST LIKE DIFFERENT PLANS ARE SIGNED UP WITH DIFFERENT DOCTORS.
WHEN YOU PARTICIPATE THIS, YOU HAVE TO CHOOSE THAT PLAN.
SO LIKE I SAID, EDNA, WELLCARE, BNS, HEALTH FIRST, ET CETERA, THERE'S A LOT OF PRIVATE HEALTH PLANS THAT WILL OFFER DIFFERENT THAT'S WHAT I'M HERE FOR.
SO THE PPO COSTS MORE OBVIOUSLY.
SO SOME FOR INSTANCE HMO, THEY'RE ZERO OUT OF POCKET.
SOME OTHERS YOU HAVE SOME COPAY TO DO.
IT REALLY DEPENDS ON WHAT YOU'RE LOOKING FOR BECAUSE WE TAILOR IT TO YOU.
SO AGAIN, YOU TELL ME, YOU KNOW, I DON'T WANNA GO INTO THE CITY, I WANNA BE IN WESTCHESTER.
THIS IS MY DOCTOR, I WANNA KEEP MY DOCTOR.
WE WILL LOOK FOR WHERE YOUR DOCTOR IS WHO'S COVERED.
AND THEN I'LL GIVE YOU MAYBE THREE OR FOUR OPTIONS.
OR IF YOU TELL ME, YOU KNOW, I DON'T WANNA CONTINUE WITH THIS DOCTOR, I BELIEVE THAT IT WON'T BE NOW 180 5.
IT'LL BE MORE THAN ONE OR 180 6.
WHAT IF YOU HAVE MEDICAID? THE MEDICAID CAN PAY FOR THAT 180 5 ABOUT MEDICAID.
IT'S REGULAR MEDICARE YOU SAID WITH 180 6 A MONTH.
AND THEN WHAT IF WE DID PART C AND YOU CHOOSE A UH, A PPO, THAT THAT HAS A COPAY.
THAT WOULD BE NOT GONNA SIX ANYMORE.
SO MAYBE LIKE THE COPAY IS $20 PER MONTH OR SOMETHING ELSE, RIGHT? IT'S SOMETHING RIGHT.
UM, THE ADVANTAGE OF THIS ONE IS, LIKE I SAID, SO LET'S SAY, YOU KNOW, HOPEFULLY DOESN'T HAPPEN TO ANYBODY, BUT YOU GO IN THE HOSPITAL AND IT HAPPENS TO SOME OF MY CLIENTS AND YOU GET A BILL FOR $45,000 AND YOU ONLY HAVE ORIGINAL MEDICARE A AND B, YOU'RE RESPONSIBLE FOR 20% OF THAT.
LITERALLY HE WENT IN ONE DAY AND IT WAS LIKE GALLBLADDER
[00:15:01]
STONES.OBVIOUSLY HE DOESN'T HAVE MEDICARE.
HE HAS, BUT UH, NO, HE HAD TO PAY OUT OF POCKET 'CAUSE HE DIDN'T HAVE HEALTH INSURANCE.
BUT I'M JUST SAYING, YOU KNOW, AN, AN EXAMPLE, IF THAT WAS TO HAPPEN TO ONE OF US WHO HAD ONLY ORIGINAL MEDICARE, YOU'LL BE RESPONSIBLE FOR 20% OF THAT.
BUT NOT WHEN YOU HAVE THE UH, MEDICARE PARTY.
AND AGAIN, THERE'S DIFFERENT PLANS.
SO IT'S TAILORED AND THAT'S SOMETHING THAT IT'S IMPORTANT TO GO ON A PERSON BY PERSON NEEDS.
UM, WE ALSO LOOK AT WHAT ARE YOUR MEDICATIONS, YOUR PRESCRIPTION, WE WANNA MAKE SURE THAT YOUR PRESCRIPTION IS COVERED.
SOME PLANS COVER ALL THE PRESCRIPTIONS.
I HAD A CLIENT WHO HAS HIGH BLOOD PRESSURE, HIGH CHOLESTEROL, OTHER THINGS GOING ON.
SHE WAS WITH ONE PLAN THAT ONLY COVERED ONE, SHE HAD TO PAY THE OTHER ONES OUT OF POCKET.
I SWITCHED HER TO A PLAN THAT COVERS ALL OF THEM.
SO NOW SHE DOESN'T PAY ANYTHING.
SO LIKE I SAID, NOT EVERY PLAN IS FOR EVERYBODY.
EVERYTHING WORKS AS AN INDIVIDUAL NEED.
AND AGAIN, SO I KIND OF TIMES TO DOCTORS, I CAN CHOOSE WITH THE PPO.
'CAUSE WITH THE PPO, THEY SHOULD BE ABLE TO TAKE IT.
NOW OBVIOUSLY, LIKE WITH ANYTHING, DOCTORS CAN TELL YOU I DON'T WANT IT OR I DON'T WANT, I DON'T TAKE IT.
BUT THEY'RE SUPPOSED TO BECAUSE THAT'S WHY YOU HAVE A PPO.
SO YOU CAN GO OUT OF NETWORK, PARTICIPATE AND WELL, SO SOMETIMES ALSO DEPENDS ON THE PLAN BECAUSE, SO THIS IS WHAT HAPPENS.
SO LET'S SAY YOU HAVE FIVE DIFFERENT PLANS, AND I'M NOT GONNA SAY NAMES.
SO EVERY PLAN CONTRACTS WITH THE DOCTOR FOR A CERTAIN SALARY.
SO AS A DOCTOR, RIGHT, IF I WANNA MAKE MORE MONEY, I'M GONNA GO WITH THE PLAN THAT PAYS ME MORE, NOT WITH THE PLAN THAT PAYS LESS OR I'M GONNA GO WITH THE PLAN THAT PAYS ME IMMEDIATELY, NOT A MONTH DOWN THE LINE.
SO THAT'S WHY IT'S IMPORTANT AGAIN, TO LOOK AT YOU, YOUR PLAN, WHAT YOU NEED, WHAT YOU WANT, AND TAKE IT FROM THERE.
BECAUSE THERE'S A LOT OF PLANS OUT THERE WITH DIFFERENT OFFERS.
SO IT MIGHT BE THAT YOU MIGHT WANNA LOOK INTO OTHER OPTIONS AND SEE WHAT WORKS FOR YOU.
ONCE YOU SIGN, YOU CAN, YOU CAN.
SO THERE'S DIFFERENT PERIODS WHERE YOU CAN, RIGHT NOW, FOR INSTANCE, WE HAD, UH, A PERIOD UNTIL MARCH 31ST WHERE YOU COULD CHANGE WITHOUT ANY PENALTIES.
BUT IT'S BEEN EXTENDED, UM, UNTIL MAY I BELIEVE.
SO FOR INDIVIDUALS WHO HAVE, UM, THE COMBINATION OF MEDICARE AND MEDICAID, IT HAS BEEN EXTENDED, BUT THERE'S DIFFERENT PERIODS WHERE YOU CAN CHANGE ALSO TOWARDS OCTOBER AND DECEMBER.
THIS MIGHT BE ONE FOR SOME PEOPLE.
SO, UM, I WAS LOOKING FOR A OLOGIST SO I CAN GET, YOU KNOW, GI YES COLON.
SO I FOUND WHEN I HAVE, YOU KNOW, I HAVE LOT OF DOCTORS IN IT, I FOUND ONE IN THAT TAKES THE PLAN, I CALL AND THE GIRL SAID, OH, I GUESS TAKE YOUR PLAN.
SHE CHECKS THE NUMBER AND EVERYTHING 30.
BUT SHE SAID, WARN THAT IF SHE DOES THE, DOES ANYTHING SURGICAL THE PLACE, HE DOES IT IN THE FACILITY, I AM NOT COVERED FOR AND I'LL BE RESPONSIBLE FOR EVERY, SHE SAYS.
SO THIS IS SOMETHING THAT PEOPLE NEED TO BE AWARE OF.
ASK THE QUESTIONS FIRST, EVEN THOUGH YOU ARE COVERED BY THAT DOCTOR.
AND I TOLD HER THEN WHY IS IT IN MY NETWORK? SHE SAID HE'S IN, BUT THE FACILITY DOES ANY SURGICAL WORK.
I'M NOT COVERED FOR, SO I'M NOT COVERED FOR EVERY HOSPITAL FOR CHESTER MEDICAL.
I'M NOT IN, BUT THEY HAVE FOR, WHAT IS IT? PLAIN HOSPITAL, RIGHT? IT VARIES, BUT I DON'T HAVE A LARGE CHOICE.
SO IT'S THE FACILITIES, YOU GOTTA BE CAREFUL, THEY DEPEND TO YOU.
SO ONE RECOMMENDATION, THE PERSON WHO SIGNED YOU OUT FOR ELDER CARE, THAT'S YOUR AGENT AND YOUR BROKER, THAT'S OUR JOB TO MAKE SURE THAT YOU DO GET WHAT YOU NEED.
LIKE IF, IF YOU SAY, YOU KNOW, I NEED YOUR HELP, YOU CAN CALL ME, YOU CAN REACH OUT TO ME, WE CAN ADVOCATE, WE CAN EVEN, UM, SEND THE INSURANCE, UM, A LETTER AND SORT OF FIGHT IT OFF.
LIKE IF YOU GET A BILL, RIGHT? SO TECHNICALLY, AGAIN, THAT'S YOUR SUPPORT PERSON.
THAT WOULD BE YOUR AGENT, YOUR BROKER, THE PERSON WHO SIGNS YOU UP.
AND WHEN FOR INSTANCE, YOU COME TO ME, I GO OVER ALL THE
[00:20:01]
OPTIONS AND YOU, YOU KNOW, I'VE HAD CLIENTS WHO TELL ME, JUST LIKE YOU, I HAVE GASTROINTESTINAL DIFFICULTIES.WE LOOK INTO THAT AND WHAT FACILITIES AND WHAT IS COVERED.
UH, X-RAY, COLONOSCOPY, UM, ANY TYPE OF OTHER RUM SWALLOW, YOU KNOW, THOSE THINGS.
YOUR BROKER OR YOUR AGENT WAS SUPPOSED TO ASK YOU AND MAKE SURE THAT THE PLAN THAT YOU GOT WAS THE BEST PLAN FOR YOU, WHICH MIGHT OR MIGHT NOT BE ELDER CARE.
BUT IT'S JUST THAT SHE SAID IT'S JUST A FACILITY.
SHE SAID THE FACILITY DOES ANYTHING OUTTA, THAT'S THE ONLY DIFFERENCE, RIGHT? BUT WE CAN LOOK IT UP AS BROKERS AND AS AGENTS WE HAVE ACCESS.
WE CAN LOOK UP THE FACILITY AND LET YOU KNOW, HEY, THIS IS NOT GONNA WORK.
DO YOU WANNA STICK WITH THAT OR DO YOU WANNA CHANGE? SO YES, YOU ARE CORRECT.
IT'S IMPORTANT TO ASK ONCE YOU'RE IN THAT PLAN.
AND THAT'S VERY GOOD INFORMATION.
HOWEVER, AGAIN, IT'S VERY IMPORTANT TO HAVE A BROKER SUPPORT.
JUST ONE QUESTION BEFORE YOU GO BY, I WANNA FORGET, BUT WHEN YOU SAID THAT THE, THE MEDICARE WENT DOWN TO ONE, BACK DOWN 180 6 I, BECAUSE I CHECKED MINE, IT'S STILL AT 2 0 2, SO IT MIGHT BE, UH, THAT THEY HAVEN'T DONE THE CHANGE YET, BUT, 'CAUSE WE JUST GOT THAT UH, NOTIFICATION LITERALLY A WEEK AGO.
UM, SO AS YOU UM MENTIONED, IT DOES INCLUDE DENTAL VISION HERE IN ACUPUNCTURE EVEN AND FREE MEMBERSHIP, UH, ALSO CAR SERVICE AND IS NOT JUST THE, UH, THE RIDE, BUT ACTUAL CAR SERVICE LIKE UBER, LYFT.
AGAIN, IT DEPENDS ON THE PLAN AND THAT'S A PART C COVERAGE.
SO THERE'S WAYS TO MAXIMIZE YOUR ADVANTAGE, YOUR MEDICARE ADVANTAGE COVERAGE.
UM, SO IF YOU HAVE, LET'S SAY THE MEDICAID AND MEDICARE AND YOU HAVE THE, WHAT WE CALL THE OTC CARD, WHICH IS OVER THE COUNTER MEDICATION, THEN DEPENDING AGAIN ON THE PLAN, THEY GET CERTAIN AMOUNTS, DIFFERENT AMOUNTS.
IT VARIES FOR 1 75 TO SIX 60 AND IT VARIES.
SOME OF THEM ARE MONTHLY, QUARTERLY, UM, SOME OF THEM ROLL OVER, SOME OF THEM DON'T.
SO AGAIN, IT DEPENDS, UM, WHAT PLAN YOU CHOOSE.
AND SOME OF THESE CARDS CAN HELP YOU ALSO PAY FOR YOUR PHONE BILL, UH, ELECTRICITY BILL, INTERNET, ET CETERA.
YOU CAN GET, UH, WITH THIS OVER THE COUNTER CARDS, YOU CAN GET VITAMINS WHICH ARE NOT REALLY PRESCRIPTION AND SOMETIMES YOU HAVE TO PAY OUT OF POCKET.
YOU CAN GET THINGS LIKE TOOTHBRUSH, SHAMPOO, SOAP, ET CETERA.
UM, SOME DENTAL IMPLANTS ARE COVERED ONLY.
IT NEEDS TO BE DETERMINED BY THE DENTIST AND BE APPROVED.
IF IT'S COSMETIC, MOST LIKELY IT WON'T BE APPROVED.
BUT IF IT'S CONSIDERED MEDICAL NECESSITY, THEN YES, IT WILL BE APPROVED.
OKAY, SO THIS IS WHAT WE CALL THE SILVER SNEAKERS FREE MEMBERSHIP.
SO WE HAVE THE ONE I GO TO, WHICH IS NEW YORK SPORTS CLUB.
AND I THINK THERE WAS ONE MORE, WHICH WAS PLANET FITNESS.
UM, AND YOU CAN JUST TAKE YOUR CAR AND ROLL AND IT'S AT NO EXTRA COST.
I'M SORRY, HAS IT ONLINE TOO? YES.
YOU CAN GO IN PERSON AND YOU CAN HAVE THE, OKAY, AND THIS IS THE PART D, WHICH YOU ALREADY KNOW.
SO WHEN YOU HAVE A AND B, YOU WILL ALSO HAVE D UH, BECAUSE YOU NEED TO HAVE THAT PRESCRIPTION COVERED.
AGAIN, WHEN YOU HAVE C YOU WILL HAVE THAT AS A BUNDLE.
YOU WILL HAVE THE HOSPITAL, THE, THE DOCTOR, AND THE PRESCRIPTION.
UM, IT'S IMPORTANT, UM, LIKE YOU MENTIONED BEFORE, TO ASK WHAT PHARMACY, 'CAUSE WITH PART D, NOT EVERY PHARMACY WILL COVER EVERY MEDICATION.
SO IT'S IMPORTANT TO SAY, HEY, ARE YOU, DO YOU WORK WITH THIS HEALTH WITH ORIGINAL MEDICARE? ARE YOU GONNA TAKE THIS? IS THIS GONNA COVER IT? AND I KNOW IT'S A LOT OF WORK, BUT AGAIN, THAT'S WHAT HAPPENS WITH PART D.
WITH PART C, IT'S A LITTLE DIFFERENT.
AND THEN THERE'S ALSO, UH, OTHER PROGRAMS THAT CAN HELP YOU PAY FOR PRESCRIPTIONS FOR, UM, OTHER MEDICINE.
I DON'T WANNA TAKE A LOT OF TIME 'CAUSE I KNOW THAT WE HAVE THE SIP AND PAIN.
UM, BUT THERE'S OTHER, UM, WAYS TO SAVE ON NOT ONLY PRESCRIPTION, BUT COPAYS.
AGAIN, IF YOU NEED MORE INFORMATION, YOU CAN REACH OUT TO ME.
I'LL HAVE MY CARDS AND I'LL PASS THEM AROUND.
AND THIS IS AGAIN, GOING OVER MEDICARE, UH, ORIGINAL MEDICARE PART A AND B.
AND UH, WHAT'S THE DIFFERENCE WITH A AND B AS OPPOSED TO PART C? RIGHT? SO IT'S COMBINED.
[00:25:01]
OKAY.SO WHEN YOU TURN 65, YOU HAVE WHAT WE CALL A SEVEN MONTH WINDOW.
SO THREE MONTH MONTHS BEFORE YOU TURN 65, THE MONTH YOU TURN 65.
AND THEN THREE MONTHS AFTER, IF YOU DON'T DO IT WITHIN THAT TIMEFRAME, THERE IS A PENALTY.
OKAY? SO IT'S IMPORTANT TO KNOW THAT.
UM, AND THEN YOU'RE AUTOMATICALLY ENROLLED IF YOU'RE RECEIVING, AS I MENTIONED EARLIER, SSDI, WHICH IS SOCIAL SECURITY DISABILITY INCOME FOR AT LEAST TWO MONTHS, I MEAN 2 24 MONTHS.
UH, AND THIS IS SORT OF A LITTLE BIT OF WHAT SOMEBODY WAS ASKING ABOUT, CAN WE SWITCH? SO WE HAVE THE ANNUAL ENROLLMENT, UH, PERIOD, AND THERE YOU CAN SWITCH WITHOUT A PENALTY FROM OCTOBER 15TH TO DECEMBER 7TH.
WE ALSO HAVE OPEN ENROLLMENT JANUARY 1ST THROUGH MARCH 31ST.
AND THEN THE SPECIAL ELECTION PERIOD.
UM, THE GENERAL ELECTION PERIOD IS THE ONE THAT JUST FINISHED ON MARCH 31ST.
SO LET'S SAY YOU ARE STUCK WITH ONE PLAN RIGHT NOW.
YOU, UH, CAN WAIT UNTIL THE NEXT PERIOD, OR UNLESS THERE'S SOMETHING REALLY URGENT, LIKE YOU SAY, I WASN'T SATISFIED.
AGAIN, IT GOES ON AN INDIVIDUAL CASE BASE, OKAY? THIS IS IN CASE YOU'RE TURNING 65 AND YOU'RE STILL WORKING.
IT'S GOOD TO KNOW THAT IF YOUR EMPLOYER HAS 20 OR MORE PEOPLE, YOU CAN DELAY MEDICARE ENROLLMENT.
IT DOESN'T MAKE SENSE FOR YOU TO GET THE DOCTOR FROM, FROM YOUR EMPLOYER AND THEN ALSO GET THE DOCTOR FOR MEDICARE AND YOU'RE NOT GONNA BE PENALIZED.
SO, YOU KNOW, LET'S SAY YOU'RE WORKING UNTIL 70 OR 75, BUT YOUR EMPLOYER DOES PROVIDE PRIVATE HEALTH INSURANCE.
AND THEN AFTER 75 YOU DECIDED YOU WANNA NOT WORK ANYMORE, YOU ENROLL INTO MEDICARE, THERE'S NO PENALIZATION BECAUSE YOU HAD COVERAGE.
OKAY? UH, IF YOUR EMPLOYER HAS UNDER 20 PEOPLE, THEN YES, YOU MUST ENROLL INTO MEDICARE.
ONE OTHER THING THAT'S IMPORTANT, UNION MEMBERS, IF YOU ARE WITH THE UNION, WE ALWAYS RECOMMEND FOR YOU TO STAY WITH THE UNION BECAUSE YOU KNOW, YOU'VE PAID YOUR DUES, IT MAKES SENSE FOR THEM TO TAKE CARE OF YOU.
UM, AND YOU WILL HAVE CERTAIN BENEFITS THAT YOU DON'T HAVE WITH MEDICARE.
AND THEN, YOU KNOW, JUST GET, BE CAREFUL WITH THE SCAMS. YOU'RE GONNA GET A LOT OF LETTERS IN THE MAIL, PHONE CALLS, EMAILS ASKING YOU TO SWITCH TO CHANGE YOUR PROVIDER OR, OR URGENT.
TAKE CARE OF, YOU KNOW, NOW CHANGE YOUR PLAN.
JUST SOMETHING TO BE AWARE OF.
AGAIN, TO ME, JUST HAVE A PERSONAL, UH, RELATIONSHIP WITH YOUR BROKER OR AGENT SO THAT IF YOU HAVE ANY CONCERNS, IF YOU NEED TO APPEAL, LIKE IN YOUR CASE YOU SAY, HEY, YOU KNOW, I'M NOT GETTING COVERAGE FOR THIS, UH, PROCEDURE, YELLA, WE WILL SHOW YOU HOW TO APPEAL.
THERE'S APPEAL, UH, AN APPEALING PROCESS.
AND SOMETIMES YOU CAN GET REJECTED THREE TIMES, BUT YOU JUST KEEP APPEALING AND EVENTUALLY, YOU KNOW, WE SUPPORT YOU WITH THAT.
AND WE'VE HAD VERY HIGH SUCCESS STORIES WHERE THEY APPEAL SEVERAL TIMES AND EVENTUALLY THEY GET PAID FOR IT.
WE HAD ONE CLIENT WHO ACTUALLY WENT OUT OF THE STATE AND SHE FORGOT TO PRESENT HER CARD AND SHE GOT, SHE HAD TO GO TO THE HOSPITAL.
WE SEND THE INFORMATION, WE APPEALED.
SO AGAIN, IT, IT VARIES IS AN INDIVIDUAL BASIS.
AND, UM, NOW WE CAN DO THE SIP AND PAN AND THANK YOU SO MUCH FOR YOUR TIME AND ATTENTION.
I'LL BE GIVING OUR CARDS AND UM, DANA, WHO'S MY, UH, SIP AND PAN PERSON AND BROKER SUPPORT WILL HELP US WITH THE PROCESS.
ONLY THE THE PRIVATE PLAN, YOU DON'T PAY A CENT.
SHE DOESN GET PAID BY SATURDAY.
YOU GET PAID BY THE, BY THE PLAN.
MAYBE YOU MIGHT WANNA PUSH A PLAN THAT NO, BECAUSE I'M, I, LIKE I SAID, I'M, I'M, UH, CONTRACTED WITH SEVERAL PLANS.
MY INTEREST IS NOT REALLY TO, UM, PUSH A PLAN.
BECAUSE LET'S SAY I AM, I GIVE YOU THIS PLAN AND THEN YOU CALL AND YOU SAY, YOU KNOW, THIS IS NOT WORKING FOR ME.
SO AS A BROKER, IT IS NOT ON MY BEST INTEREST TO SELL YOU WHATEVER PLAN I FEEL IS BEST FOR YOU.
I HAVE TO CHOOSE A PLAN TO WORK FOR YOU AS LONG AS YOU DON'T CHANGE PLAN.
[00:30:01]
AND, AND YOU KNOW, AT ANY POINT IN TIME WHERE YOU CAN CHANGE AND YOU SAY, HEY, YOU KNOW, I'M NOT HAPPY WITH YOU.I'M GONNA GO TO ANOTHER BROKER AND I WANNA, THEN I DON'T GET YES, BECAUSE WE HAVE INFORMATION AND WE GET INFORMATION SOMETIMES AHEAD OF TIME BEFORE THE CLIENT SAID, PLUS A LOT OF THIS INFORMATION IS VERY CONFUSING.
I WAS A SPEECH PATHOLOGIST BEFORE I BECAME A BROKER AND ONE OF THE REASONS I DID THIS IS TO HELP MY AGING PARENTS AND AUNTS, THEY DON'T SPEAK ENGLISH.
I'M BILINGUAL SPANISH AND I WAS VERY CONFUSED MYSELF.
SO I WALKED INTO ONE OF THESE MEDICARE OFFICE TO HELP MY MOTHER.
UM, TOUCH ON OTHER, THIS IS, YEAH.
'CAUSE I DON'T WANNA TAKE TIME FROM THE ACTUAL ACTIVITY THAT I KNOW BROUGHT US HERE, OBVIOUSLY.
AND EVEN IF YOU'RE JUST CURIOUS, YOU CAN SAY, HEY YELLA, I WAS IN THE, UH, PRESENTATION.
I HAVE THESE QUESTIONS AND I'LL RESPOND.
SO IT'S DOWNTOWN AND HUNDRED AND 25TH, BUT I 120 FIFTH.
BUT I LIVE HERE IN HASTING AND I CAN COME TO YOUR HOME IF THAT WORKS.