Ep. 244 – Understanding Medicare Advantage Open Enrollment in Retirement

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In this Episode of the Secure Your Retirement Podcast, Radon and Murs have our in-house Medicare specialist, Shawn Southard, discuss the Medicare Advantage open enrollment. With an education background and a servant’s heart, Shawn is passionate about helping people find the right Medicare plans.

Listen in to learn about the benefits of a Medicare Advantage plan and the reasons for the Medicare Advantage open enrollment period. You will also learn why someone would choose to go with a Medicare Advantage plan over the original Medicare plan, plus the strategic downsides of the former.

In this episode, find out:

●     The couple times you can get into Medicare in a year and the open enrollment available for Medicare Advantage holders.

●     Medicare Advantage plan – all the same benefits offered by original Medicare plus a few extra things.

●     The reasons why people do a Medicare Advantage plan as opposed to the original Medicare plan.

●     The strategic downsides of going with a Medicare Advantage plan, which includes their network plans.

●     Why a Medicare Advantage holder would want to change from one plan to another within the plan.

Tweetable Quotes:

●     “Medicare Advantage or Part C is just another way people can get their health coverage during their Medicare journey.” – Shawn Southard

●     “If you’re a Medicare Advantage holder, you can use the time from January 1st to March 31st to find another Medicare Advantage plan that your doctor is in a network.”– Shawn Southard

Resources:

If you are in or nearing retirement and you want to gain clarity on what questions you should be asking, learn what the biggest retirement myths are, and identify what you can do to achieve peace of mind for your retirement, get started today by requesting our complimentary video course, Four Steps to Secure Your Retirement!

To access the course, simply visit POMWealth.net/podcast.

Here’s the full transcript:

Radon Stancil:	Welcome to Secure Your Retirement podcast. We are excited to have you with us. It’s amazing that we’re having these conversations again already in 2024, but we are excited about today’s episode. The reason why is because here at Peace of Mind Wealth Management, we actually decided Medicare is so important for our clients and those that are becoming our clients, that we thought we need to have our own in-house Medicare specialist. So we’re excited to debut with you, Shawn Southard.
	So let me just say this. First of all, Shawn, thank you so much for coming on and chatting, and we appreciate having you as a part of the team here at Peace of Mind as well. Thank you now for spending some time with us explaining some of these, I don’t know, detailed topics around Medicare.
Shawn Southard:	Oh, you’re welcome, and thank you. Thank you both for having me and giving me the opportunity to do that.
Radon Stancil:	Great. So let me give some context here. If you’re listening to this and you’re 65 years of age and older, you know exactly what Medicare is. You understand that. If you are anywhere close to 65, you probably are very clear about what Medicare is. There’s some planning that goes into play and there’s a couple of key elements throughout the year that all kind of comes together when it comes to Medicare and Medicare planning.
	So what we’re going to do is every month we are going to feature a Medicare podcast where we’re going to have Shawn come on. Shawn’s going to help us with common questions, things that we might have seen, real life situations that we dealt with maybe over the course of the month. Some real things that we think can be beneficial around this idea of Medicare. So we’re excited. Here we are in January. This is our first true Medicare focused podcast, and we’re going to do one of these every single month. So we’re excited. So I’m going to let Murs kind of get the topic started for what we’re talking about here in January.
Murs Tariq:	Yeah, and before I do that, I got to say I’m very excited too. In client meetings oftentimes the Medicare conversation comes up, and to be honest with you, there’s a lot to know about Medicare. There’s a lot of pieces and bells and whistles that you got to understand. To have a specialist in-house now at this point now what we can confidently say is, “Hey, we’ve got an expert here, and so make sure you go talk to Shawn.” Rather than delaying the conversation and trying to find the appropriate answer, now we’ve got a very, very strong resource, so I hope everyone listening appreciates that.
	Let’s talk about Medicare and let’s talk about firstly open enrollment. I think that’s going to lead into why we’re doing this episode today specific to an open enrollment period that we are upon or coming up upon. Shawn, can you walk us through Medicare from an open enrollment period? A lot of times people think there’s only a couple times where you can get on Medicare when you turn 65 or this open enrollment at the end of the year. It turns out there’s another one that we are just about to come up on here in January. So can you walk us through, help people understand what those are?
Shawn Southard:	Sure, absolutely. Well, as you mentioned, there’s a few ways to get into Medicare. Obviously the big one is approaching 65. Or when some people are still working beyond 65, so once they retire and leave their group health plans, that’s the time that they need to get into Medicare.
	Then of course, every year in the fall, October 15th to December 7th, and it’s the same dates every year. It doesn’t matter what day of the week it is, it’s always October 15th to December 7th. So eight weeks in the fall. That’s generally when over 95% of all Medicare beneficiaries make changes to their plans or to the structure that they have, whether it’s original Medicare only, and they want to get into a Med Advantage Plan, or they want to supplement original Medicare with a Medigap or supplement policy, change their prescription drug plans, whatever the case may be. That’s when most of that’s going on.
	Then in January, a number of years ago, CMS, Centers for Medicare and Medicaid Services decided to give another open enrollment, especially since Medicare Advantage was taking off so well and the popularity was growing and growing. As we all know, once in a while, I always joke around, I say in my mind, I go somewhere else. I always go to Cancun in my mind because I love the tropics and I love being warm. So a lot of people tend to go to Cancun in their mind sometimes during open enrollment in the fall and they miss or they overlook their ANOC, which stands for annual notice of change. The carriers are required to send those out every year to plan holders, which highlights and delineates any changes to their plans coming up for the next year. Sometimes they overlook that information or don’t get a chance to review it.
	Then come January they realize that there’s been some changes to their plans that doesn’t work well for them anymore. So for Medicare Advantage policy holders only Medicare has given them from January 1st to March 31st, another chance to make a change to their plan if they need to. So they can change to a different Med Advantage Plan within the same company. Or they can change different companies altogether to one of their plans. Or if they want, they can dis-enroll from a Med Advantage Plan and go back to original Medicare. So that’s where the point we are in now. It’s called Medicare Advantage Open Enrollment, and that goes from January one to March 31st every year, same dates.
Radon Stancil:	All right, so I’m going to give a little bit of, I don’t know, a disclosure or disclaimer here that says we’re going to use some terminology that you may or may not know or be aware of. Don’t worry about that because as I said, we’re going to work through this all throughout the year and we’ll come back and hit topics. Let me just say this, Medicare is in all essence insurance that we get through the government, but then there’s not, all of everything is not covered. There’s some gaps within Medicare.
	So there’s a couple different ways to cover those gaps and that could be a Medigap plan. Then there’s this other side over here that you’re using this terminology, Shawn, called Medicare Advantage. So could you help us to just have a high level, if I were to say, what is a Medicare Advantage Plan? Could you just explain it to me for a second?
Shawn Southard:	Absolutely. So like you say, once at a high level Medicare Advantage, you probably hear the different letters people talk about. When they talk about Medicare, they throw out letters, they throw out A, B, C, D. You hear these letters being talked about all the time. So real briefly, Medicare, original Medicare is two parts. It’s part A and part B. Part A is your hospital coverage, and part B is your medical coverage. Doctor’s coverage is otherwise known as and, or all of your outpatient procedures and so forth are going to go under your Part B of Medicare. Part D is prescription, standalone prescription drug plans. That’s part D. Part C as in Charlie, is Medicare Advantage. They were known as Medicare Advantage cost plans or Medicare cost plans originally, and then they became Medicare Advantage. So Medicare Advantage is just another way that people can get their health coverage during their Medicare journey.
	Medicare Advantage is not original Medicare, but it’s their private plans that are drawn up by insurance companies that have been gone through the approval process with Medicare and CMS. They have to offer all the same benefits that original Medicare offers in part A and part B. However, Med Advantage with the advantage part, they offer some things that original Medicare does not. So for example, all preventative services for dental, you’ll have dental coverage. You’ll have vision coverage for your eye exams and help with contacts or frames or new lenses for your glasses. Hearing aids and hearing exams, et cetera. Things like that are put into Med Advantage Plans and built in there. They also offer there’s many Med Advantage Plans that have their coverage, the Medicare drug coverage combined in there. So it’s just another way that people can get their health coverage during their Medicare journey. It’s called Medicare Advantage or Part C.
Murs Tariq:	Okay, great. So that’s a great explanation. So obviously if you’re listening now you’re like, okay, well I’ve got A, B, C, D, and then it continues to go off after that, a whole alphabet soup of all these different directions where I can go to get my medical coverage in retirement through Medicare, and then how do I cover gaps in between and everything like that. So it can be quite a bit is how I’m already feeling. As I’m hearing you talk about it, and I’m sure everyone else, unless you’ve already figured this out for yourself. Maybe you’re 63 and you’re like, “I don’t know anything about this. How do I decide? Do I go with original Medicare and the Part D or do I look into Part C?” Why would someone join Medicare Advantage as opposed to just taking original Medicare?
Shawn Southard:	Sure. Well, that’s a great question. Medicare Advantage, one of the big reasons why people do a Medicare Advantage Plan is for some of the reasons why I’ve already mentioned is original Medicare covers things that are medically necessary. That’d be a whole probably blog in and of itself or I don’t even know if we want to open that Pandora’s box of why Congress, the members of Congress decide on what’s medically necessary and what’s not medically necessary. So in the infinite wisdom there currently, original Medicare does not cover preventative services like dental and vision and things like that.
	So if you are on original Medicare part A and part B and you decide to do a supplement route or a Medigap plan, those things are not going to be covered for you unfortunately because Medicare does not deem them as medically necessary. So one of the attractive things about Medicare Advantage, people are used to having those things covered under their health plans all through their life, through their group health plans or standalone plans that they may have from the marketplace.
	They have those coverages, they are used to going to get their annual physical exams, their teeth cleanings, their eye exams, et cetera, et cetera. So Med Advantage allows the Medicare beneficiary to have those things built in from the plants and people really find those attractive. Another reason is cost. People who have original Medicare part A and part B and do a Medigap plan, the Medigap plan is a standalone, it’s an insurance policy basically. That’s what you’re doing is for extra premium, you’re buying another policy to cover, as Radon said, the gaps in original Medicare, but it has a monthly premium.
	It can range anywhere, depends on what plan you get because there’s a number of Medigap plans also denoted by letters. So we’re even increasing the alphabet soup here. They have premiums and they can range anywhere from 130 to $150 a month depending on what carrier you go with, et cetera, et cetera. What discounts they may or may not offer. Okay. So it’s an extra cost that people have to incur every month to cover the gaps of original Medicare.
	Whereas Medicare Advantage, there’s a lot of great plans in this area, in the triangle area that are zero premiums. So you can have this other policy that has all the coverages that original Medicare offers, plus extra benefits like the dental and the vision and the annual physical exams and so forth for no cost to you. So those are some of the big reasons why people do consider Medicare Advantage plans and go that route.
Murs Tariq:	So let me interject there just for the sake of balance, because there’s a pro and a con to everything. We talk about that all the time when it comes to investing, strategies, taxation, you can’t do everything perfectly. So what would be a one or two reasons as to why someone wouldn’t go with the Part C or the Medicare Advantage?
Shawn Southard:	That’s also a great question. One of the biggest things is, and of course we’re trying to keep it a high level today, but would love to get into the weeds with anyone that would want to give me a call or touch base with me. Basically I guess one of the downsides to going the Medicare Advantage route is their network plans. So they have networks, networks of doctors, networks of hospitals. So there’s HMOs, health maintenance organizations, which are smaller networks, and then there’s PPOs, preferred provider organizations which are bigger, more robust networks.
	When you get into a Med Advantage Plan, just like you have probably used to during most of your life in your group health plans or individual health plan, that’s how they work. They’re major medical plans with cost sharing, co-sharing and with networks. In original Medicare, the way it’s structured when you’re on part A and part B and with a supplement for example, there are no networks. So you can go anywhere you want under that structure as long as the provider, the medical provider accepts Medicare and Medicare patients.
	So if you’re traveling, if you’re a big traveler, especially in retirement, or if you have children and grandchildren scattered across the country and you live here in North Carolina, but you’re going to be in Arizona for two months and you’re on original Medicare with a supplement, if anything were to happen to you, health-wise, you don’t have to really worry if I’m in network or not. As long as the provider has an appointment where you can get in and they also take Medicare patients, you can go see any primary care physician, specialist, it doesn’t matter.
	With Medicare Advantage, it does matter. It really does matter whether that person is in the network or not, because if they’re not, you’re going to pay… With the HMOs, you have to stay in network. There is no out of network benefits. In a PPO there is. You’re going to pay more out of network and then in some cases you may have to pay the full freight depending upon the situation.
	Strategically speaking, strategy wise, that’s one of the things that I thoroughly cover with people when they come to see me in the process that I do, is we really look at everything and we look at their lifestyle, we look at their health. We look at things that they think they want to do and kind of put all that together and say, “All right, well, given the different pathways we can go here, what is going to be best for you?” I know none of us have a magic ball, crystal ball we can see in the future. So you only can make the best decisions at the moment, at the time with the information you have, but we really try to uncover everything to make sure that they are in the best possible situation for them and their family.
Radon Stancil:	Excellent. So we’re talking now, going back to specifically Medicare Advantage. We are now in this phase of time, as you mentioned, from January one to March 31st, where we could, if a person has Medicare Advantage already, they could make a change from one place to the other. So now the question that I’d like to ask is could you give us some reasons why somebody might want to change from one plan to another within the Medicare Advantage world?
Shawn Southard:	Sure. That’s a great question. Fair question. So some of the things that, as I mentioned earlier, what I found through my years of working with folks in Medicare is the biggest thing because a lot of times I will get a lot of referrals and I inherit people in their situations. So sometimes there isn’t anything I can do because things have already been done beforehand that can’t be undone. I try to do the best I possibly can if a change is needed to help them understand what they can do and get them to where they need to be.
	One of the biggest things that I find is their agents, they’ve lost touch with their former agents or that kind of thing, and they’re just floating along. In the fall, Medicare requires all Med Advantage Plans to send out something called an ANOC. That’s an acronym, ANOC, that’s annual notice of change. So basically what that is it’s informing the policy holders of a Med Advantage Plan that this particular plan that you have is going to have changes and these are the changes. They delineate the changes in this document.
	Many, many, many Med Advantage policy holders overlook this document. They don’t take the time to read it. They don’t have an agent that’s following up with them to say, “Hey, you should have received your ANOC. Do you have any questions about that? Do you want to talk about that?” Then in January, because all the plans start anew on January 1st, they renew on January 1st, so the Medicare beneficiary in that policy now comes January. It wasn’t realized that the doctor that they used to use is no longer in network, and then they go to the doctors and they’re like, “Oh my gosh, you don’t take my plan?” They’re totally caught off guard and frightened, rightfully so. That’s a scary situation to find yourself in.
	So if you find yourself in that situation and you are a Medicare Advantage policy holder, you can use this time from January 1st or March 31st to find another Medicare Advantage plan that your doctor is accepting and is in the network. I would say that’s probably one of the biggest things of why people use this time period to make a change.
Murs Tariq:	All right, well, Shawn, this has been great. Thanks for spending some time with us today. I’m sure as the listeners have been listening to you talk, they clearly can, I would think, understand that quite a bit about Medicare and everything that goes into making that decision. That’s frankly one of the reasons why you’re now part of the Peace of Mind team.
	So you started to allude to how you help people make the decision a little bit earlier, but can you help our listeners understand what the process is, how you help them make the decision on what plan to be going with, and then also what type of documents are you looking for to understand what their current scenario is?
Shawn Southard:	Sure, absolutely. I appreciate that. So just real quickly, just we’re all getting to know each other and especially the listeners here. My background eons ago when I actually didn’t have all this white hair, but I started off as a high school teacher and was a corporate trainer for about seven years. So education is part of who I am, it’s a fundamental core value of mine. I really see myself as an educator with a servant’s heart. That’s how I describe myself.
	So that’s all about education, and that’s one thing that I really love about Peace of Mind Wealth Management. One of the things that when I first met you all was I was thoroughly impressed with how all of us here are so into educating the client. So that is the biggest piece of the process is educating. I want to make sure that every person that I meet with and talk to, that we are taking the time to make sure that we’re explaining and educating them on what options are available, what pathways are available, and of course we need to thoroughly dive into the situation.
	So I’m going to get to know people pretty well through the process. I need to know what your health conditions are. No need to be embarrassed, it’s just part of life that things happen to people. If you’re going to hold that back, I’m not going to really be able to help you as well as I can, if I don’t know some of the situations that you’re in health-wise. I’m going to need to know the medications, prescription drugs that you take to help you find the best plans that are going to help you get the medicines that you need at a cost that’s going to be viable and affordable for you and your family.
	It’s going to be a discovery process. Those are some of the things that we will need to have people be able to get their hands on and bring or get to me and just have open conversations and share maybe some of your hopes and your dreams of where you want to go to and things that you’re doing and traveling, because that’s going to help with us. That’s going to help us in the process to figure out whether you should do original Medicare with a supplement and, or maybe consider doing a Med Advantage Plan.
	Also, as we know, we do finances here too, needing to know that framework as well. Not probably as much depth as you two would need to know, but I definitely need to know some information there because cost is also an important factor in this whole process. At the end of the day, if you can’t afford the pathway you want to go on, it’s going to all blow up on you anyway, so that’s a really important thing too.
Radon Stancil:	Excellent. Well, Shawn, we certainly do appreciate you taking the time to do this. We’re excited to be able to do this every month because Medicare is complicated. I mean, I know that I’ve been around doing this for 22 years. I started off doing Medicare. I haven’t done it now in well over 15 years. If you’re not doing it every day, it’s complicated and we appreciate you coming on and explaining it. So thank you so much. We appreciate it. We look forward to talking to you again next month.
Shawn Southard:	Yeah, same here. I’m looking forward to it, and thank you so much. Appreciate it.