Navigating the labyrinth of Medicare options can be overwhelming, especially for those nearing or past the age of 65. In this riveting episode of “Connecting the Community with Chris,” we’re joined by Tyrone Carr, a seasoned Medicare and Insurance specialist, to shed light on how to make informed, educated choices about Medicare. Read on as we delve into the ins and outs of eligibility, enrollment, and much more. Trust us, this is one discussion you won’t want to miss!
Watch the full podcast or read the transcript below:
Chris: Hello, welcome to Connecting the Community with Chris. I am excited to have Tyrone Carr as our special guest today. He is a Medicare and Insurance expert and specializes in making sure that you find the right plan for yourself when it comes down to Medicare and making sure it’s appropriate and the Affordable Care that we’re all looking for.
So, thank you for coming to our show today.
Tyrone: Thank you for having me, Chris. I appreciate it. Yeah, as Chris mentioned, my name is Tyrone Carr, owner of Tyrone Carr & Associates. We’re a Medicare planning agency here in the state of Michigan, Southeastern Michigan specifically, our office is in Brighton, and we just take a lot of pride in just helping you know, our seniors in the community, just make an informed, educated decision. No pressure. And again, our focus is just on the education and helping people in our community.
Chris: Yeah, pleasure. You know, tell us how did you get into the industry?
Tyrone: Wow, that’s, that’s a long story. I originally went to school for teaching Special Ed EI (Early Intervention) and you know, ran into some health issues myself, and I kind of just, kind of fell into it by accident and at you know, your 20s, who knows about Medicare, right? And so, just experiencing some of my own health issues, and spending a lot of time unfortunately in the hospital and doctor’s offices, I learned a little bit about it. But through a friend who’s already in the industry, he was a partner at another firm, and he spoke to me about like, what it’s all about and what they do and so, here we are almost 18 years later and not looking back.
Chris: That’s great. Serving the most important community I believe and in our area, you know, making sure that our seniors are safe, and also, making the right decisions is really important to us. So, I know that a lot of the questions that we’re going to ask you are things that are really important, that some might even, just are searching for or not even think about, and that is the eligibility of Medicare. Can you explain to us, you know, a little bit about the eligibility and, you know, enrolling?
Tyrone: Well, it’s you know, anybody, you know, for someone who is turning 65, you know, that’s, those are typically the aging individual can enroll into Medicare Part A and Part B. There are certainly people that are on Medicare Disability, which you could be someone due to an accident or, you know, you were born with some form of disability impairment that, you know, as a young adult you could qualify for Medicare Part A and Part B. But typically, it’s for someone that is turning 65, they would apply for Medicare 90 days prior to the month in which they turned 65.
Chris: Okay, and obviously call an expert like you to discuss other options.
Tyrone: Yeah, I think, you know, the biggest thing that we see is, when people come into our office, is the uncertainty of what those steps are – whether it’s applying, should I take Social Security, should I, do I need to take Medicare Part A and Part B, you know, am I working, you know, whether it be health related, do I need a drug plan. There’s a lot of, you know, uncertainty that they have, and like, what is the next steps. And so, you know, what we really focus on is just the education and helping guide them along the way, so, that way those choices, the decision that they need to make, which for a lot of people are the big decisions, as they go into that, you know, the latter chapter of life. And so, we want to give them the self-confidence and knowing that the decisions that they are going to make are the right ones for their specific means.
Chris: Throughout life we’re going through different changes, you know, and so, you know, obviously it doesn’t matter, it doesn’t stop what age you are, if you know from your 30s or 40s, or 40s or 50s, every 10 years we have to make different decisions in our life. And I know that the changes in Medicare, you know, change for us Healthcare professionals too, you know, every five years. It can be making a decision depending on however the level of care we provide.
But what changes have you seen in specifically in the Medicare Insurance arena in the last five years?
Tyrone: I would say that some of the biggest changes that we’ve seen are certainly on the improvement of Medicare Advantage plan, you know, and some of the benefits, you know, ancillary benefits that they’ve integrated inside of the plans, they’re certainly becoming more attractive to people in the community for a variety of different reasons, one being a lower cost point than a traditional Medicare supplemental insurance. You know, you’re not having to pay for a separate drug plan if you choose a Medigap plan. You know, some of the certain plans have international coverage, so, it’s important, like here in the state of Michigan you have 73 different Medicare Advantage plans, you know, a lot of people that can become over, it’s overwhelming in itself. So, not only identifying, you know, is the Medicare Advantage plan right for myself or my, me and my spouse, or is it a Medigap plan. So, distinguishing the differences between those two, let alone 73 Medicare Advantage plans. And those numbers vary based upon counties, so, and there’s a number of variables that you take in consideration. So, it’s not just about is it the right time to take Medicare, should I start taking a social security check, but, how does that plan, you know, one of the questions we ask, you know, do you travel, you know, whether it be inside the state of Michigan, do you travel throughout the United States, do you travel internationally, which a lot of our clients travel internationally. So, not all Medicare Advantage plans are the same. Now, what you find, clients you know, let’s say they’ve come to us, let’s say they’ve been in Medicare for a couple of years and they’ve been on Medicare Advantage and you know, we’ll ask the question what was the determining factor that led to you choosing this specific, let’s say Blue Cross Blue Shield plan, “well, it was free.” Okay, well, let’s say out of the 48 plans are offered in your particular County that are PPO plans, 35 of them are free, so, what else did you take in consideration? So, it’s you know, are you a diabetic, how does that plan affect you if you’re a diabetic, if you’re not on oral medications, or if you’re on diabetes or on insulin, if you, you know, where do you travel to, you know, some of those ancillary benefits, you know, for using it for like hearing aid or if it’s over the counter benefit, you need it for transportation. And one of the things that can be really confusing if I were to present to you let’s say summary benefit pamphlets from two different carriers, in one particular carrier on the hearing aid benefit would show a zero copay. Now, you would think that if I go to purchase a hearing aid that would pay a zero copay for that hearing aid.
Chris: And hearing aids are expensive.
Tyrone: Exactly and those completely paid, those can be anywhere from a thousand to up to over five thousand dollars a hearing aid. So, when you look at that summary of benefit and you read that as what’s a zero copay, what the summary benefit doesn’t show you or disclose that they put a cap on the dollar amount that they’ll cover for that hearing aid. So, for example, some carriers, they’ll cap you at two thousand dollars. So, if you’re anticipating going into purchasing hearing aid and that hearing aid is going to be a zero copay, but it’s a five-thousand-dollar hearing aid, you’re gonna have to come up with the difference. Whereas another carrier will show you their co-pay as, it’s graded, so, it could be anywhere from, you know, $295 up to $1500, where some of the carriers don’t put a cap on that. So, you’re better off to go with a plan that shows a copay rather than a plan that, if that’s the specific reason why you’re choosing that plan, and it doesn’t disclose, so as an agent, as an advisor …
Chris: That’s your number one disability that you have in life. Like you have, you don’t have any heart failures, no diabetes, you’ve been healthy all your life, but the hearing is like, that is what drives you to going to the, you know, your Physician.
Tyrone: So, it’s you know, and I don’t ever like, I never want to make people feel like I’m trying to sell you something. So, I’m always asking a lot of questions and sometimes I’m asking questions through experience. And so, based on experiences where people have had, well I chose this Medicare Advantage using the hearing aid as an example for that specific reason. It’s not like, well were you aware of this and so, and if you do travel internationally some carriers only provide a fifty-thousand-dollar maximum benefit. If you travel internationally, as someone who does travel internationally, and who actually just got home at 2 A.M this morning from Mexico …
Chris: To make our podcast.
Tyrone: (Laughs) So, it’s, you know, those are one of those things that, you know, if you have one of those Medicare Advantage plans, that’s ultimately the plan that is what’s best for you based upon a number of circumstances or variables, then I would recommend you as your agent, you should have a travel policy that’s going to cover you beyond that fifty thousand dollars, and then versus, well if this plan checks all the boxes, but this carrier also provides 100% unlimited coverage for International Medical coverage, then I would suggest that one. So, a lot of times it’s not that a person just doesn’t know the right questions to ask, and also, you know, you can get a different response depending on how you frame a question.
So, for a perfect example, you contact your doctor’s office, and this was a question that was actually was proposed, it was last week, before I left for vacation, and they had asked or I always told, my doctors don’t accept this carrier United Healthcare. Okay, well, if I just go and say, do you guys accept United Healthcare? Well, is it United Healthcare Individual Plan, is it a Group Plan, is it an HMO, is it a PPO, is it a Dual-SNP (Special Needs Plan), is it the Medicare Advantage, is it the Medigap policy?
So, if you’re just asking, that’s just the person who’s in the doctor’s office may be, asking that question and or answering your question based upon how you frame that question. So, you could have a different answer versus being very specific. Do you, does Doctor, you know, Patel, does he accept, you know, United Healthcare Medicare Advantage PPO? So, you’re very specific, well then, versus, does he accept United Healthcare Medicare Advantage HMO, or is he accepting Dual-SNP?
So, they may accept the PPO but not the HMO Advantage. So, if you’re not framing that question specific enough, you could get a completely different answer not the thing that you want to hear. And then of course, then we get the phone call – well, you told us that they accepted, and because we always do the, we verify whether those doctors are a network or not.
Chris: Yeah, you want to ask how specific were you, you know, and be very specific. So, that’s a good tip for everybody in their strategy, making sure that you’re trying to, you know, check with your providers, be very specific on your plan, you know, because it could be a differentiator or picking the right provider.
Now, how do you decipher with your clients how much coverage they actually need? I know that like you said, like I feel like that you want to know about their life, their life experiences, their health history, you want to know their activity of their life, you know, that helps you put them in the right plan.
Tyrone: Well, you know, we always ask questions that are important to helping us guide you into making the best decision for yourself. Now, whether someone chooses to use us as their agent or as their agency, moving forward, you know, we always ask questions that with a purpose and so, it’s not just to be nosy. And so, I think you know, certainly understanding like, what their family history is like, you know, what medications, do you travel, like is it just local, is it you know up North, is it you know, do you have a second home, do you travel internationally, you know, are you extremely active, are you not married? So, there are certainly benefits to that, you know. It’s, are you anticipating, do you have any currently, any diagnosis have you had, what has your past health, you know, conditions look like, you know, you can have someone like, I have no family history of cancer, but you can be that that outlier where five years ago you had cancer, so you know, you’re a diabetic, are you having, you know, surgery?
So, if someone’s coming to us and saying they’re turning 65 and they’re anticipating having like you know, knee replacement, maybe both knees replaced, we’re more likely going to recommend a completely different plan for that specific reason, because we want to minimize or eliminate any out-of-pocket costs as much as we possibly can.
Chris: Here’s a question for you that we get all the time, which is, say I work past the age of 65. And so, how do you enroll into Medicare? Does that change anything?
Tyrone: It certainly does and that’s something that is becoming more and more common for a number of different reasons. So, what a lot of people and there’s you know, we’ve certainly have dealt with clients that have worked past age 65, well until later you know, 60s or even 70s, and they’ve elected to take Medicare. So, it’s, somebody else said, “well I was told I have to.” Well, I don’t know what that person’s experiences or why they told you that, but it’s really contingent on if how many employees you have. So, let’s say you work for employer, they provide health care benefits, I’ll use an example. A church that we assisted earlier this year, actually last year, and this particular church I was referred by another professional and one of the assistant pastors came to us – him and his wife. And he was eligible for Medicare. So, they’re provided full health care benefits through the congregation. The congregation also has a school, so you know, their question was, do I have to take Medicare? Well, because there was more than 20 employees, you’re not required to by law to take Medicare. So, they were anticipating taking Medicare. Now, I’m not suggesting that that’s what I’m, I told them to do, but to your question, they’re not required to as long as there’s more than 20 employees, and you’re participating in that group insurance.
So, a lot of times, people make the mistake of, well, I’m going to enroll into Medicare because my employer told me to. Well, the HR department may not understand Medicare, kind of the rules and laws with inside of Medicare that would be applicable to that business or that entity.
So, I told them you’re not required to, however, we always want to look at what are you paying, what is your contribution towards the insurance. Now, the congregation was paying 100 percent of the premiums for both him, the assistant pastor, and his wife. Now they’re both soon to be eligible for Medicare, so the church was paying just over two thousand dollars a month between the two of them.
So, what we proposed is actually they come off of the group insurance plan, go on original Medicare, pay the Medicare premium and then just have the church reimburse them for the cost of, so, come to find out after looking at the group, there was three individuals that were of Medicare age on that group and so, by taking them off of that group, and the church just reimbursed them for their benefits and we ended up saving them forty nine thousand dollars, between the three families, just insurance premiums. And not only that, we took them, they had a thousand-dollar deductible per individual with a two thousand dollar max out of pocket. It was a PPO, so it was still a good overall network, but there’s nothing that compares original Medicare and a Medigap policy.
Because Medicare is a federal benefit, so you have the benefit of being able to choose any doctor, any Hospital, not only the state in which you reside, but throughout the United States. So, we took them each from a total combined family doctor with two thousand dollars down to you know, 446 dollars or and deductible so, and that essentially is our max out of pocket. So, the benefits were substantially increased, and we saved the church forty-nine thousand dollars.
Chris: So, you recommend this for all businesses?
Tyrone: We always, you know, anytime that we’re given the opportunity to look at a business, we always want to look at, you know, first of all, how many number of employees are there, if there’s anybody that’s of Medicare age, you know, and then if they have a spouse, you have to take in consideration, is the spouse of Medicare age. So, there’s a number of variables that we have to take in consideration. But you know, and if there’s less than 20 employees, they’re required to take Medicare. So, even though they’re on, so, even though they’re participating in the group insurance plan, if there’s less than 20 employees, they’re required to take original Medicare.
So, it’s a, naturally a cost that… so, you always like, you would approach, you know, reviewing any type of or evaluating whether the current plan is still what’s recommended. We always look at you know, is it cost of just paying for Medicare and Medigap policy by itself and coming out the group, does that make sense. A lot of times you know, it does, not always, but a lot of times it does, especially if you’re a small to medium-sized business. I mean you’re saving forty-nine thousand dollars a year in premium for just three people, that’s pretty, that’s substantial.
Chris: Yeah, definitely, yeah, I mean that’s a huge cost savings and I would understand that. Do you find a lot of business owners know this or are you finding that when you consult with business owners that they are not educated on this.
Tyrone: No, they don’t. That’s, you know, that’s one of the reasons why we’ve brought a lot of these services in house, you know, a lot of you know, Specialists, you know, you have, they’re like silos, and so they just hyper focus on their area of expertise, and because that’s all they know, they don’t understand you know. Like a lot of financial advisors, they hyper focus on just accumulating wealth, but they don’t realize that that affects your Medicare, that affects your auto. So, there’s a lot of things, that how Medicare is like a spider web, or it has like all these different tentacles that are reflecting all these different areas of life.
And so, as Medicare advisors, we want to speak to that. And so, we may suggest, hey, you go talk to your financial guy, person, or go talk to your CPA.
Chris: I have to ask a question. How does it affect your Auto?
Tyrone: So, Medicare you know, we have underneath the Auto Reform Act which you know, went into place you know, July 1st of 2020. So, where’s, Medicare is responsible for … so, you’re having a lot of people that are you know, they’re asking the question how does this, can I eliminate my medical coverage, you know, for, on my auto? Well, Medicare some of those coverages are limited when it comes to the auto, so I would suggest let’s certainly look at your policy…
Chris: Your Medicare could, bodily injury can be kept,
Tyrone: Correct.
Chris: Versus, if you have Auto, No Cap.
Tyrone: Correct.
Chris: Depending on the policy that you pick.
Tyrone: Correct. So, it’s important that your home and auto insurance agent understands how that affects Medicare and typically because again, they’re like that Silo, they know the Property and Casualty piece of it, so you’ll hear one say, “well, no, Medicare covers it.” Well, because they don’t understand Medicare, that advice recommendation isn’t necessarily in their best interest. So you know…
Chris: I keep hearing, making sure you have full coverage on your auto insurance, making sure they’re the carrier, don’t make Medicare the primary for the auto.
Tyrone: Yeah. So, when we’re addressing that with our clients, you know, if you can you know, afford the unlimited coverage, I always recommended a few, and I understand that certain people, you know, to save you know, a few hundred bucks on a yearly basis, is important, is significant, you know, when you’re on a fixed income. So, I get that. But in our experience, sometimes, the risk to the savings after they’ve learned a little bit more about it …
Chris: Yeah, I see the out-of-pocket cost of, you know, God forbid, someone becomes quadriplegic or paraplegic, no one, a small percentage of Americans have funds to cover Round the Clock care, you know, and you need the insurance, and you need the care, you know, and that’s why you’re gambling.
Tyrone: Well, it’s you know, we always use it, it’s like you know, purchase the insurance with the intent of using it, right, I mean I certainly you know, own my auto and you know, certainly Medical. But you have it because you’re transferring the risk from your pocket to the obviously, insurance carrier.
Chris: How much will Medicare cost the average senior in 2023?
Tyrone: So, per individual right now, it’s about forty-eight hundred dollars, you know, if you’re choosing original Medicare with a Medicare supplemental insurance.
Chris: Okay and then, do seniors need to renew their Medicare coverage every single year?
Tyrone: So, whatever plan you choose, it automatically renews. We always as an agency, always recommend having a review. We do reviews every year with our clients, sometimes twice a year, just you know, because life happens, right. Medications may change, either you’re on fewer, more medications, you know, something that you know, a diagnosis or an accident may have occurred.
So, it’s important for us you know, to continue to provide you, you know, the support and the recommendations that may be necessary…
Chris: …as life changes over time. Now, what is the general Medicare deductible?
Tyrone: So, your Medicare Part A deductible in 2023 is sixteen hundred dollars per year, and that’s per benefit period. And then your Part B deductible is 223 dollars, so, and then the part B is once you’ve met for the years then it’s exhausted. So, whether you meet in January or December um then there would be…
Chris: Is that across the board, all states? Or just that’s Michigan?
Tyrone: Yeah, it’s Federal.
Chris: Okay, it’s Federal. So, what is the difference between Medicare HMO and Medicare PPO?
Tyrone: So, an HMO is just a Health Management Organization, whereas a PPO is a Preferred Provider Organization. So, in HMO the costs are generally significantly less, as far as internally between co-pays, co-insurance, and max out of pockets. Whereas, PPOs you know, your costs can be higher. The HMO, the downside to it is, you know, referrals, your limited networks. So, you have to use those doctors are in networks. So again, it goes back to ask the agent, asking the right questions. So, not just addressing the questions that they have, but also, you need to be aware of this and so that’s what we take a lot of pride in. You know, the PPO, it just gives you more of that flexibility of being able to choose your doctors. If you’re someone that travels, I wouldn’t suggest an HMO.
Chris: Okay. That’s good to know. Now, will Medicare cover in-home care after a hospitalization?
Tyrone: So, in-home care if you’re helping, that it’s not going to be private duties, so, as you know.
Chris: Yeah, so, the difference between Home Health and Private Duty. So, let me reword this and say, will Medicare cover Home Health Care?
Tyrone: It will cover home health care but sometimes people don’t understand the differentiator between Home Health Care and Private Duty Care. And so, you know, it’s the definition of, yes, if you just want a clear answer, but again, it’s the devils in the details, right. So, it comes into, when we’re meeting some of them very first time, those are some of those things that we go over in detail, that way you understand that it is in this situation or unforeseen accident or diagnosis, that you do have proper coverage, because again, what people think is, Home Health Care versus Private Duty Care are two completely different worlds.
Chris: You want to know if your family members do have planned surgeries coming up in the next year, you know, if you’re going to plan on getting rehab, you know, that’s something that you know, a question you’re going to raise.
Now, will Medicare cover Private Duty Care?
Tyrone: So, that’s a no right. So, again, there’s the devil in the details and I think that’s you know, a good agent that will really break that down and explain to you how and what that looks like. So, one of the bullet points that when we were kind of talking about earlier, is you know, a person could, you had a stroke, and you need care and maybe you’re going to be inside of a nursing home or assisted living facility for a period of time. So, Medicare will cover you 20 days, but there’s a catch. You have to be admitted into a hospital first as an inpatient for three consecutive days. So, if you don’t meet that three days as an inpatient, the Medicare is not going to give you the 20 days. And if you’re a person, has chosen a Medigap plan, the Medigap is only going to cover days 21 through 100 if Medicare is approved the first 20 days.
Chris: So, if I am coded as an inpatient versus, is there another way?
Tyrone: Observed. So, give you an example quickly. So, if let’s say, you had a stroke and you’re in the hospital for five days, nothing around your surroundings changed, you’re seeing the same doctors on a daily basis, therapist, same food, same room, you’re there for five days and naturally you would think that “hey, I’ve spent three days.” Well, but if they change the coding from inpatient to being observed, let’s say on the third day, you’re not meeting that minimum requirement.
Yes, the Medicare is that that covers the 20 days and the Medigap, and so which at that point you’re self-insuring. So again, those are some of those specific details that we get into when we’re interviewing or having a conversation.
Chris: If you plan on going to rehab that can be a differentiator. Now, there’s differences between Medicare Advantage and Medicare Gap and I want to make sure that we’re very clear on this when our viewers are watching this, because it’s really important.
Now, let’s just talk about Medicare Advantage. What’s the definition of that type of insurance?
Tyrone: So, Medicare Advantage is kind of like we talked about in the previous, you know, question, is you know, is defined either as an HMO – Health Maintenance Organization or a PPO. So, Medicare Advantage is you know, more private fee for service. So, they essentially, they have their network of doctors. So, it’s a little bit more flexible for people that are of Medicare age, that are on a fixed income, or they like the flexibility of having a plan that they’re not obligated to pay a monthly premium.
So, versus you know, a Medigap policy, you know, you have more fixed cost, you know, on a monthly basis.
Chris: So, you’re getting a bill every single month versus Medicare Advantage you’re not getting billed every single month.
Tyrone: Yeah, and it’s in a Medicare Advantage that’s offered through you know, the private insurance carriers, so you know, whereas a Medigap plan, it works in conjunction with original Medicare. So, Medicare is a primary, the Medigap is a secondary, so they work together. Whereas Medicare Advantage is essentially going to replace the Medicare, so everything’s bundled into one policy.
Chris: Can I choose my own doctor with Medicare Advantage?
Tyrone: Yes and no. Because, I mean, you do, we do want to verify whether or not that your doctors are in network. So, if you have a set of doctors that you’re currently and have been seeing for you know, a period of time, whether it be years, you know, we certainly want to make certain that there are networks.
Chris: So, you still are on a Medicare Advantage, you have to make sure that the doctor that you want is in network with the MA program.
Tyrone: Correct. So, Medicare Advantage you know, there’s, I always talk about you know, there’s you know, three different types of clients you know. So, there’s individual you know, after we explain what a Medigap policy is and they love the fact that the Medigap gives them you know, the greatest level of flexibility of choosing doctors and hospitals, whether it be here in Michigan or …
Chris: They don’t have to be in network of Medicare again.
Tyrone: Correct. And then a Medigap provides you know, like you just know what your cost is, you know, there’s like this is what it is, so, you pay a monthly premium, and everything’s covered 100% you know, minus your Part B deductible. Medicare Advantage, it provides the flexibility of not having to pay a monthly premium for the majority of the plans, but there’s out of pocket cost and you have to make certain that your doctors are in network.
So, if a person who comes to us and says, “hey, you know Tyrone, I love the idea that you know, the Medigap plan, clearly, I can see from just pure Health Care benefits it’s the better option, but I can’t afford a traditional Medigap plan.” So, and I always preface this too whether you know, when we’re meeting somebody, when you hear the term Medigap or Medicare supplemental insurance, it’s the exact same thing. Medicare Advantage, if you hear the term Medicare Advantage or Part C, it’s the same thing.
So, Medicare Advantage is someone who says that, one, I can’t afford them at a gap plan, but I certainly can afford a Medicare Advantage that doesn’t cost me on a monthly basis. So that would be client number one.
The second standard would be a person who says, “you know Tyrone, I see the value of the Medicare Advantage, you pay a fixed monthly premium, and I don’t have to worry about really anything out of my pocket other than the Part B deductible. But you know what, I’m healthy, you know, I maintain a healthy lifestyle, I exercise, extremely eat healthy, my family history of you know, good genes, my parents lived a long, healthy life, so, I like the idea of choosing Medicare Advantage and getting the benefits of those things, you know from like the free gym membership, the hearing aids, on the you know, teeth cleanings, and you know, some of the over-the-counter benefits. So, they’re okay with that risk of having an out-of-pocket cost.
The third person is the person who comes to us and says you know, I like the idea of having like the free gym membership, I like the idea of the over the counter benefit Medicare Advantage, the hearing aid benefits and all the stuff, but I’m someone who says, you know what, I’m turning 65, and I’ve got all these health issues and the likelihood I’m going to pay all this out of pocket costs associated with Medicare Advantage, you know, we would more likely support a Medigap plan because you pay a monthly premium, you know what you get.
Chris: I think that’s a good differentiator question is you want to know their history well and so that would be you know, obviously a big game changer for them you know, if they have to pick their provider.
Now, does Medicare benefits change every year?
Tyrone: They certainly can, you know, like your deductibles are going to change, your Part B premium is going to change, your part B deductible is going to change, you know, drug coverage. So, there’s certainly a lot of moving parts that can change, so that’s why we always recommend having a review. Sometimes you know, those reviews could take a matter of a few minutes, you know, sometimes they’re more involved depending on what life changes may have happened in your life.
Chris: So, say I moved to Florida. Will it change?
Tyrone: So, if you have original Medicare in a Medigap plan, it’s not going to change. You know, so, typically if you have a current Medicare Advantage plan, once you move outside of the service area of that plan, you’re going to be required to change. Now, every state is different as far as the Medicare Advantage. So, we do a lot of business in Florida, and so the max out of pockets are significantly higher in Florida than they are here in the state of Michigan. I would say out of the 16 states that we do business in, I would say Michigan from an Advantage standpoint or it’s probably one of the better ones just from a standpoint of your max out of pockets aren’t as high.
Chris: So, if you move to Florida, do you want to talk to them?
Tyrone: Yes, absolutely.
Chris: So, if you’re a Medicare Advantage in Michigan great, that worked for you here, but if you’re moving out of state, let’s talk about Medigap, so that way you are…
Tyrone: Or if you have a Medigap and you’re moving down there. I mean, no matter whether you have a Medigap or Medicare Advantage, if you’re moving outside to a different County or certainly different state, we certainly want to …
Chris: …talk to your insurance advisor. Now, enrollment period, it begins in 2024. What is this particular, specific time frame that we all should know? Because you know, we you know, running around, we don’t always remember our dates and when it is time to come, we’re not making the right decision, which is because we’re stressed trying to figure out all these plans.
Tyrone: Yeah, so you have, there’s all these different enrollment periods. So, like you have the fall time, which most of us are or most seniors are familiar with, which is AEP, stands for Annual Election Period. So, that’s October 15th through December 7th. So, this is a time period that anybody who is actively on Medicare, they can choose to make a change to their drug plan, which any change would begin January 1st or they can change from one Medicare Advantage plan over to a different Medicare Advantage plan, within that side that seven week window, if maybe you know, we did a review on October 1st, we submit an application October 15th, for January 1st of you know, effective date, but then something happened between October 15th and December 7th, maybe an accident or a diagnosis, and maybe you’re now on another medication, maybe they took you off of medication, or maybe this diagnosis, you know, permanent you know chronic illness, then we may want to review that again and evaluate that plan and suggest if we could make another change.
Chris: But once you’re locked in, you’re locked in?
Tyrone: For that, for, so, from that January 1st until December 14th of the following year, if you didn’t make any changes. Now, if a person that has a Medicare Advantage wants to go to original Medicare in a Medigap, they certainly can do that, but to go from a Medicare Advantage to a Medigap, under most circumstances, you know, you have to medically qualify to make a change. If a person starts out on the Medigap, let’s say you’ve been on that Medigap policy for three, four, five years, so you know I’m healthy, and you know what, I’m hearing about all these Medicare Advantage plans, and watching the commercials, I’m hearing about on the radio, an advertisement piece comes in the mail, talking to my peers and family members, I think this is something I want to explore. You can certainly go from a Medigap to an Advantage plan.
Now, one of the points that I always make clear is, anytime you’re transitioning from one Medicare Advantage over to another, you never have to medically qualify. To go from a Medigap to an Advantage, you never have to medically qualify. If you’re transitioning from, someone says, “hey, I’m going to try out a Medicare Advantage,” and you have a bunch of health issues, we make it clear – you try on that Medicare Advantage and then let’s say two, three years down the road you want to try going back to a Medigap plan, because it’s not, you’re realizing, like the cost, I’m meeting the max out of pocket every single year or close to it, you have to medically qualify to go back to a Medigap policy.
Some people underneath the Obamacare, the Affordable Care Act, that, “oh, pre-existing conditions don’t apply.” That’s not true. There’s a number of questions that we have to ask and so we certainly don’t want people to enroll into an Advantage without being aware of what you can or can’t do. Because in the end it’s a reflection of me as an agent, but also a reflection of our agency. And you know, we certainly don’t want to put anybody in a …
Chris: Yeah, we want to give them informed information, it can help their life you know, and protect them.
Now, we covered a lot of information regarding Medicare. Is there any other question or you know any thing that could be helpful for our seniors during enrollment period of time or before it?
Tyrone: You know, I would make certain that agent that you’re speaking with is someone who’s experienced, you know. I was, I would, and I always make this recommendation as well, don’t ever contact an Insurance Carrier directly. They do not have your best interests at heart, you know.
For example, if you contact Blue Cross Blue Shield, Blue Cross Blue Shield is going to sell you or offer you plans that are Blue Cross Blue Shield. They’re not going to say that “hey, you know, we can, let’s talk about United Healthcare, HAP, or Humana, or Priority health or Aetna,” because there’s nothing financially for them to gain right. So, there’s certainly could be a low level of bias you know. As a broker having access to all the different carriers, it doesn’t make a difference to us. I mean, we do care, but from a financial standpoint, it doesn’t make a difference. We’re not making more money if you go with Blue Cross Blue Shield over Priority Health or HAP or Humana or any other carrier.
So, our end goal is to make certain that we find the absolute best plan for you specifically.
So, to my point – don’t ever contact insurance carrier directly and make certain that you’re having your plan reviewed on a yearly basis.
Chris: Well, you heard it from the expert, Tyrone. You know, he is great at making sure that he talks about your life and understand what’s going on in your daily activities and how important it is to understand what your changes are in your life to make sure that your family are making the right informed decision which is something that really, you know, 65 is a very young age now, and so, you live very long, making sure that you have really good insurance coverage.
It’s going to be important for all of our seniors. And so, thank you for joining in our show.
Tyrone: Appreciate it very much.
Chris: We appreciate you and we look forward to having more information and education resources for our community to share.
Tyrone: Yeah, look forward to it. Thanks Chris.
Chris: Thank you.
If you have any questions regarding Medicare, please give Tyrone and his team a call. Tyrone, what’s the best way to contact you?
Tyrone: You can reach us at, our office line is 810-534-3008. Our website is www.tcarrassociates.com. You’re going to find us on Facebook, Instagram. You can even actually give us a call on my cell phone – 810-623-9262 as well.
Chris: Great, thank you.
Tyrone: You’re welcome. Thank you for having us.