EPISODE OVERVIEW:

Join host Betty as she sits down with Medicare expert Julia Wiswell from Wiswell Insurance to navigate the often confusing world of Medicare and retirement healthcare planning. In this comprehensive discussion, Julia breaks down Medicare’s essential components and shares practical guidance for selecting the right coverage to meet your needs and budget.

TIME STAMPS:

[2:36] Medicare Considerations

• Timelines for enrolling
• Eligibility requirements 

[10:42] Cost differences

• Comparison of costs
• Options available for coverage

[17:59] Medicare Misconceptions 

• Common misconceptions
• Underwriting process

[23:56] Co-pays and Payment

• How co-pay works
• Out-of-pocket costs for Medicare 

[29:01] Enrollment into Medicare

• Enrollment process
• The need to review plans regularly

KEY TAKEAWAYS: 

• Importance of Medicare planning – Start Medicare planning early to avoid costly enrollment penalties and coverage gap 
• Factors influencing your choice – How Medicare expenses compare across different plan options and what coverage choices are available to you 
• Misconceptions that exist for Medicare – Common misconceptions that trip people up and what the underwriting process really looks like 
• Challenges faced when making Medicare decisions – Prepare for the unique challenges of managing Medicare decisions for aging family members 
• Managing healthcare planning long term – Develop long-term healthcare strategies that support both your personal and professional goals

GUEST INFO: 

Julia Wiswell, Medicare

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RESOURCES: 

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Betty Wang is an investment adviser representative of BW Financial LLC, a registered investment adviser registered in the State of Colorado. Registration does not imply a certain level of skill or training. The views and opinions expressed are as of the date of publication and are subject to change. The content is for informational or educational purposes only, and is not intended as individualized investment advice. This information should not be relied upon as the sole factor in an investment-making decision. You are encouraged to consult with a financial professional to address your specific needs and circumstances.

TRANSCRIPTION: 

Betty Wang 00:00:06 A critical component of anyone’s retirement plan is planning for health care costs. Today, we are going to focus on Medicare and what you need to know whether you are approaching retirement or helping a loved one navigate their options. Understanding Medicare can help you make informed decisions and secure a healthier future. I’m Betty Wang, the host of Betty Smart Friends. I’m a certified financial planner who helps women be more empowered and feel less alone in their financial lives. Joining us today is Julia Whitesell. Julia is the owner of Whistle Insurance and she’s a Medicare specialist. I’m so excited to share her insights with you. Please welcome Julia to the podcast. Hi, Julia.

Julia Wiswell 00:00:50 Hi. Thanks for having me, buddy.

Betty Wang 00:00:52 Thanks so much for joining us. I guess let’s start a little bit about you. Can you share your background and How you found health insurance and Medicare as a field for your profession and your business.

Julia Wiswell 00:01:07 Yeah, so I’m a Medicare broker. And so I consider myself a broker. So that just means that I contract with multiple carriers to give our clients access to care and choices in providers and what’s best for them.

Julia Wiswell 00:01:23 I’ve been doing this for ten years now, and we’re an agency based in North Denver, and I just got into it randomly at a at a networking event. And, it was the the year after ACA, Obamacare started, and it was just such an unknown industry for people to, to be able to navigate. So it it just kind of worked out. And then I fell in love with, with insurance and helping people and offering some, you know, insight into a really confusing industry for people.

Betty Wang 00:01:59 Yes, it’s super confusing.

Julia Wiswell 00:02:01 Yes, a lot of moving parts.

Betty Wang 00:02:03 Yes. So I mean, today we’re just going to focus on Medicare, and I think we could feel more time than we have allotted. But because it is confusing for somebody who is just starting to think about enrolling in Medicare, they’re like, okay, well, you know, I’m I’m going to be turning 65 next year or in a couple of years. What should they start thinking about?

Julia Wiswell 00:02:24 Yeah. So I would say the big thing is making sure that they, you know, are starting to think about it in a timely manner.

Julia Wiswell 00:02:32 I would say usually six months is an ideal time for people to start having the thought of, all right, 65 is approaching or you’re thinking about retirement, some of this stuff, it is hard to start very early just because it is a lot of information. And so if you’re starting, you know, years prior, it’s good information to have. But it is a lot to absorb. And so I think ideally starting around the six month mark is great for people and and really, we would start the enrollment process three months prior to their effective date is as soon as we can really start the process in terms of paperwork and and plan selection. So yeah, I think it’s kind of a good 6 to 3 month timeframe.

Betty Wang 00:03:15 Well, because it changes every year too. Is that right?

Julia Wiswell 00:03:19 Yes. In terms of like, when, you know, when somebody is eligible essentially just based on their on their birthdays. But the open enrollment period for people is is standard from October 15th through December 7th. So that part doesn’t change.

Julia Wiswell 00:03:35 but yeah, it is a throughout the year. It is, you know, changing for people on on their eligibility and their circumstance.

Betty Wang 00:03:42 And what are the can you explain to folks what the different parts of Medicare are and what they need to know? I know that’s yes, it’s complicated.

Julia Wiswell 00:03:50 All the letters of the alphabet.

Betty Wang 00:03:52 Yeah. All the letters are very confusing.

Julia Wiswell 00:03:55 Yes. I mean, in general, The the bigger parts of Medicare are part A, B, C, and D, those are the most common. You know, referred to Medicare parts. And so part A will cover your overnight hospital stays. Hospice care skilled nursing facility. And part B covers everything else medically. So your doctors visits your bloodwork imaging, urgent care, emergency services, injections, infusions, all of that’s billed under Medicare Part B, and part A and part B are referred to as original Medicare. Those are the core parts of somebody getting on Medicare. And then D would be D’s for drugs. So that’s their prescription drug plan that will cover retail filling prescriptions, not an injection or infusion that’s offered at a medical facility.

Julia Wiswell 00:04:44 So D is just for retail filling prescriptions. And then part C is referred to as an advantage plan. So part C and an advantage plan mean the same exact thing. And this is where somebody like myself comes in and we work with the insurance carriers that offer Medicare Advantage plans and walking through people. You know, our clients, what each plan covers and what their needs are. So the C is part C is the advantage plan that basically bundles in your part A, your part B, and part D. Generally, your prescription drug plan is kind of referred to as the bundle package for part C.

Betty Wang 00:05:25 So can you just spend a little more time there. Because I think that’s where it gets confusing, where it’s like it’s just called original Medicare and Medicare Advantage. What are the main differences between them? Yeah. What should people know?

Julia Wiswell 00:05:37 I would say so, yeah. Because a lot of times we’re like, oh, I have Medicare. But you also have a Medicare Advantage plan. And technically you do have both.

Julia Wiswell 00:05:45 You have to have both to be on an advantage plan. But the Medicare Part A and part B is you’re essentially just using Medicare’s network. So you can go to any provider that accepts Medicare. And if you do a Medicare Advantage plan, this is where the insurance companies come in, such as United or Humana, Aetna, all the insurance companies that offer advantage plans. That’s who your insurance is with now. You no longer have Medicare in terms of network coverage or benefits when you enroll in an advantage plan. Now you’re subject to that particular carrier’s benefits, possibly their network coverage. So just main factor is benefits. What’s available to you and network access.

Betty Wang 00:06:32 What do you see when people are trying to decide between the two. Like what’s the advantage of one versus the other?

Julia Wiswell 00:06:39 Yes, the ultimate question.

Betty Wang 00:06:41 Yeah, we got to it fast.

Julia Wiswell 00:06:44 Yes you did. You wasted no time. I love that.

Betty Wang 00:06:46 Well, I think this is the most confusing part, even for myself, right? It’s like, what do you do? Okay.

Betty Wang 00:06:53 Yeah. You’re.. What do you do? What’s the difference? What are. Am I stuck? If I choose one, can I never choose the other? Those sorts of things.

Julia Wiswell 00:07:01 That is the ultimate question. I would say the two biggest factors between the two. You know, between original Medicare and an advantage plan would be we talked about network access. But diving more into that network access. With original Medicare, it’s usually a little bit greater because it’s much like having a PPO where they can go, you know, nationwide, they can see any provider that accepts Medicare. They typically don’t need a referral to see a specialist. So it’s very flexible network Medicare is very flexible with the advantage plan. Typically you choose between an HMO or a PPO. And so sometimes people feel that they’re a little more network restricted, especially if you’re on an HMO plan, you know you’re bound to a carrier’s network. And so sometimes that means you can’t see a specific, you know, doctor or facility, or maybe you don’t have access in a different state, especially if you have a house.

Julia Wiswell 00:08:01 You know, if you have somebody that’s snowbirds. And so sometimes that doesn’t sit well with people being a little more network restricted. But on the flip side to that, Medicare Advantage plan can sometimes be affordable on a monthly aspect because most plans don’t have a monthly premium. And if somebody is very healthy and is okay with, you know, being network restricted to the Front Range here in Colorado specifically, that tends to work well for people. They’re okay with, you know, saving monthly and okay with not accessing care necessarily out of Colorado, outside of Colorado. And it is very tailored, you know, to what works for your specific needs. Are you really set on accessing care outside of Colorado if you needed to? Is that something that ranks very important to you or, you know, do you spend time out of the state for a certain amount of months? Do you do a lot of traveling? Do you want to make sure that you can easily access care nationwide? So those are factors that are really important for somebody when they’re deciding what route do I go.

Julia Wiswell 00:09:07 Do I go with, you know, Medicare with a supplement or do I go with a Medicare Advantage part C? And I would say network and cost are the two main factors in that decision.

Betty Wang 00:09:17 So Medicare with a supplement does that tend to be more expensive than Medicare Advantage.

Julia Wiswell 00:09:24 Yeah it can be depending, you know, on how somebody is using the plan from a from a monthly aspect. It is more expensive because with the supplement you have an extra premium with the advantage plan. Generally most of them are around $0. So right away from a from a monthly perspective. Medicare with the supplement is going to cost more. Now does that monthly premium, you know, collectively over 12 months. Is that more than an out-of-pocket maximum on an advantage plan? Sometimes it’s less. And so, you know, that’s the other factor of somebody very sickly or a high medical user. You can save with the supplement plan where the flip side is, if somebody’s not a high medical user and they’re okay with having, you know, some co-pays, if they were to go to use the plan.

Julia Wiswell 00:10:14 The advantage plan from a from a monthly perspective can be less well.

Betty Wang 00:10:18 And I know some of my clients like the advantage plans because also some of them come with vision and dental care too. And that’s something that.

Julia Wiswell 00:10:26 Great.

Betty Wang 00:10:27 Point Medicare with supplements does not. Is that correct? Correct.

Julia Wiswell 00:10:32 Yeah. Medicare with the supplement is kind of like the a la carte option. You know, you’re getting a separate dental plan a separate vision plan, separate prescription drug plan where part C is referred to that that bundle package, just as you said, it does include most of the time dental vision, your prescription drug plan. Sometimes they’ll offer extra benefits. You know, like an over-the-counter benefit where you could purchase vitamins and eyedrops and cough syrup. So yeah, it does it does give some of those extra benefits. And if that’s important to somebody, you know, a lot of times we’ll deal with clients like I use more dental coverage than I do medical like dental. Number one priority to me. So you know and that that could be a good option for somebody that’s if that’s important to them.

Julia Wiswell 00:11:14 And keeping the the monthly premium lower.

Betty Wang 00:11:16 So if a client came to you to talk about enrolling in Medicare, can you walk us through like what questions or what that looks like for you to guide them to what makes most sense for them?

Julia Wiswell 00:11:29 Yeah. So a lot of times, you know, I’ll start with what’s important to you in terms of of network access. A lot of a lot of people haven’t been asked the question, if you were to get sick, is it important for you to go to Mayo Clinic? Is it important for you to be able to to access care outside of Colorado is if that’s not important to you, that kind of helps me, you know, narrow in on. Okay, we can, you know, maybe look at an HMO plan that doesn’t scare them. So definitely, you know, what’s important to them as far as accessing care, also their health, you know, typically a lot of times people wait until they’re 65 on Medicare to get a joint replacement. And so if that’s something that’s upcoming, that’s a cost that we’ll talk about network access, making sure that they can see those providers that they want to go to, but really just kind of getting to know the client and what’s important to them.

Julia Wiswell 00:12:20 Prescription drugs is another factor on what they’re taking regularly or injections or infusions as well. You know how how people are using their health care really day to day.

Betty Wang 00:12:31 Do you find that one that Medicare versus Medicare Advantage or the advantage plans ones better or more cost effective or covers more drugs? I mean, do you find one is better than the other or just sort of depends?

Julia Wiswell 00:12:47 Well, that question is a great question, but with particular in 2025, the Medicare Advantage plans and the prescription drug plans now have a $2,000 max out of pocket. So that was a little more important in terms of who was really covering what carrier was really covering that particular drug better, and that sometimes required a little more research on our end. But now with this $2,000 maximum for for 2025, that means that the the client won’t pay more than $2,000 a year for all of their prescriptions. As long as that prescriptions on the formulary. And so that has kind of changed the landscape a little bit in terms of, you know, shopping for prescription drug plans.

Julia Wiswell 00:13:31 If somebody is taking a very expensive drug like Eliquis or XR Alto or an inhaler. You know, these clients are probably going to reach a $2,000 maximum on prescription drugs. And so it, you know, gives a little more flexibility, I would say, for us because most drugs are covered. It’s not really how you’re going to get there. It’s when. So they’ll tend to reach. That is what we’re finding for this year. And that will, you know, also be years to come unless legislation changes that. But it was a good change. It’s a it’s at least a step in the right direction for people.

Betty Wang 00:14:08 Hi listeners. Hope you are laughing and learning from this episode of Betty Smart Friends. Here’s a quick tip. Maintain an emergency fund. No matter how much you earn. Having a financial cushion or an oh shit fund is key. Try to save 6 to 8 months worth of living expenses in a liquid, easily accessible account for the times that life unexpectedly punches you in the face.

Betty Wang 00:14:34 Thanks for being a listener. Now back to the show. What about folks who are unhealthy? They’re coming up to Medicare and they’re having they’ve had a lot of health issues. Is there one plan that seems to. Tends to be better than the other? Or I mean, just to be clear, Medicare. Has to take you, right? There’s no underwriting, right?

Julia Wiswell 00:14:59 In certain instances, there can be. And, you know, that is something that I want to.

Betty Wang 00:15:03 Misconception.

Julia Wiswell 00:15:04 Address I feel like that is a little bit of a very much. Yes. And so somebody that’s very unhealthy typically the supplemental plan could be a better option because when you add up the monthly premium, it still could be less than a max out of pocket on an advantage plan. And also somebody that’s typically a little more unhealthy or high medical user wants access to care. They don’t want to be, you know, looking up, gosh, can I go see Doctor Smith or can I go see a this doctor.

Julia Wiswell 00:15:32 You know, it gives them that open flexibility to worry a little bit less on where they can go or who they can see. And there is a point where the cost of your Medicare supplemental plan And essentially is the same cost as a max out of pocket on the advantage plan. So there is a break, you know, break even, I would say, which is usually for somebody around 75 or older, you know, that tends to start to equal out. So then at that point it’s not necessarily a cost factor. It’s more of how easily do you want to be able to access providers. Yeah. That’s a generally that’s typically that conversation goes with somebody that’s a high medical user.

Betty Wang 00:16:09 I mean, now that we’re on misconceptions like what other misconceptions? I think there’s a lot of them out there. What other ones would you like to sort of shed some light on for us?

Julia Wiswell 00:16:19 Yeah. So just going back to underwriting really quick. So underwriting there’s no underwriting. When somebody first turns 65 and gets on Medicare, they can choose any Medicare Advantage plan, no questions asked.

Julia Wiswell 00:16:30 Or they can choose any supplemental plan with any carrier, no medical questions asked. The underwriting comes in if somebody’s been on a Medicare advantage plan for, you know, five, ten years, and then they want to go on a Medicare supplemental plan, that’s when they’re going to go through underwriting. And at that point, the insurance company does have the option to deny that person coverage. They will look into that client’s medical history and choose either to accept or deny them. And so that can be a challenge for some people. But they’re looking for big stuff like liver, heart lung issues, joint replacements, hospitalizations. So that’s not to scare people that you can’t get through underwriting. We have people get through underwriting. But it is something that is a potential, you know, kind of an overhang on people. The other time that there’s no underwriting is if somebody is retiring. So they’re past age 65, maybe they’re 70. They’ve decided to work a little bit longer and then they want to go on Medicare.

Julia Wiswell 00:17:27 Again, there’s no underwriting at that point either. As long as they are just applying for Medicare. Part B is what kind of determines whether underwriting is a factor or not. And so those people can also get a Medicare supplement with no underwriting even though they’re past age 65. But yeah, those are typically when underwriting. You know, we hear that a lot. Like when we tell people that they’re like, oh, I never thought there was pre-existing conditions or underwriting. But for the most part there isn’t. But there are cases where underwriting could be a challenge.

Betty Wang 00:17:57 You’re saying that you’re not stuck in Medicare or an advantage plan. You can switch between the two.

Julia Wiswell 00:18:03 You can always switch between the two. During the open enrollment period. But if somebody’s been on an advantage plan for, you know, over two years, essentially, then to go to the supplement, they would go through underwriting. But anybody can get an advantage.

Betty Wang 00:18:16 So it’s you kind of want to you kind of want to maybe understand if you have preexisting conditions, if when you’re deciding initially not that you’re stuck, but you just have to know that there’s more paperwork or kind of more of a headache if you decide to switch later, then very much.

Betty Wang 00:18:35 Is that.

Julia Wiswell 00:18:35 Fair? Yes, absolutely. Yeah, that that initial, you know, decision is a big factor because there is no underwriting at first. And so yes, that is a very important decision when you’re first getting on Medicare is what makes sense right away from the beginning.

Betty Wang 00:18:51 Well, and so I mean, I feel like probably a lot of people try to do this on their own, but they don’t know as much as you know. I don’t know, I just feel like they’re at a disadvantage then. Right?

Julia Wiswell 00:19:02 It’s a lot it’s a lot of information to to consume and digest.

Betty Wang 00:19:07 Well, I think there’s another, you know, misconception that Medicare pays for everything. On the podcast, we’ve had someone talk about long term care. So we’ve definitely talked about that. You know, long term care is not is not covered by Medicare. But I think people don’t realize that there’s premiums, that there are co-pays and all that kind of stuff. Can you talk us through that a little bit because it’s not all free? Yeah, it would be amazing.

Betty Wang 00:19:42 But not. Not at this time.

Julia Wiswell 00:19:44 That’s right, that’s right. No, that is a I agree, that is a that is a little bit of a of a misconception because everybody generally unless you know, we’re dealing with somebody that’s on Medicaid, low income state insurance. But some people are even surprised that you pay for part B. You know, they’re like, oh, I didn’t realize I had to pay a monthly premium. And so that everybody pays for part B, you know? So regardless, if you go with an advantage or a supplemental plan. So sometimes people are surprised. They’re like, wow, I didn’t realize I even had a monthly premium for part B. But yeah, I would say, you know, in in general, that’s that’s definitely a factor. And long term care is another one that, that you mentioned that is not covered by any Medicare plan, whether it’s an advantage or a supplemental plan. You know, that’s all out of pocket custodial long term care. So that that is a factor.

Julia Wiswell 00:20:38 What else. But I mean, generally for the most part, you know people how people are using health insurance. Things pretty much covered in terms of like hospitalizations and joint replacements and surgeries and things like that. You know, there isn’t a difference between somebody’s health insurance plan and Medicare. It’s very similar. Cosmetic procedures, of course, will not be covered. That’s not any different. But, you know, for more routine medical services, that’s all pretty much covered on Medicare, just like it would be on a health insurance plan.

Betty Wang 00:21:08 So will people be getting, you know, right now, our insurance rate, we get this, oh, we’ll insurance pay this much and you have to pay this. Are there co-payments with traditional Medicare or with the Medicare Advantage plans?

Julia Wiswell 00:21:25 Yeah. And so you’ll get Bob’s estimate of benefits with Medicare or an advantage plan, just like you would on, you know, a traditional health insurance plan. And with Medicare, there are deductibles for for part A and a deductible for part B.

Julia Wiswell 00:21:40 And then generally that particular individual would pay 20% coinsurance after those deductibles have been met. So that’s pretty traditional. You have a deductible, then you pay a percentage. You typically pay that percentage until you reach a maximum out of pocket. With Medicare there is no max out of pocket, which is why people get some sort of secondary insurance to help give that that protection, that stop loss. And so you either do that by paying for the Medicare supplemental plan or by enrolling in the advantage plan, and then having that max out of pocket. Generally, the advantage plans are set up where you don’t pay the monthly premium and then you have co-pays. So each service essentially has a cost. And that cost is going towards a maximum out-of-pocket. And once that’s been reached then that person is covered 100% for the year. Okay. Yeah a little bit different.

Betty Wang 00:22:25 Yeah. No, it’s it’s a lot of information.

Julia Wiswell 00:22:28 Yeah.

Betty Wang 00:22:29 Do you get compensated differently by pointing people into different directions? I mean, I think that’s important for people to know because I think people are more and more skeptical of going to brokers like they’re trying to sell me something.

Betty Wang 00:22:44 I mean, I know that that’s not you, but it’s you know, I think it’s important for people to know how someone like you might be compensated. And I’m sure it’s different for, for different firms. But if they were to come to you, how does that work?

Julia Wiswell 00:22:57 Yeah. So in general, we pretty much have a contract with every carrier. And so we are compensated by that insurance company. So if somebody were to go out and enroll in their own Medicare Advantage plan or Medicare supplement plan, you know, they would have the same plans, same costs as what we would offer. So we’re not offering any sort of discounts or anything, you know, to our clients. And then as far as compensation goes, we are compensated by the insurance company, which is why there’s no cost to an individual to use a broker. So we do not charge like a consulting fee or anything extra. We get the our commission from the insurance company. It does vary.

Betty Wang 00:23:36 And the clients price the clients client’s pricing, to be clear, is exactly the same, though.

Julia Wiswell 00:23:41 Exactly the same.

Betty Wang 00:23:42 So they’re getting the benefit of your knowledge without for the same price.

Julia Wiswell 00:23:47 Yeah, absolutely. Yeah. That’s right. Exactly.

Betty Wang 00:23:50 What if you’re like, well, I think Medicare, traditional Medicare works better. How does that work for you? Do you get compensated there or not really?

Julia Wiswell 00:24:00 No. Because with Medicare, they’re essentially it’s the client would enroll in Medicare Part A and part B online through the Social Security website. And so that’s not something that we can enroll in them on their behalf, I should say, so that we can walk them through doing it through their Social Security account. But it’s not something that we can fully take over and do on their behalf. I mean, we pretty much never recommend that just because because of that 20% accrual that does that doesn’t give them that max out of pocket. So if something catastrophic were to happen or even a, you know, a very expensive ailment like cancer. You know, that client is going to continue to pay 20%, 20% of all of those medical expenses where if they had some sort of supplemental plan or the advantage plan, it gives them that protection that says, all right, this is the most I’m gonna pay for these medical expenses for the year.

Julia Wiswell 00:24:52 So it’s never our recommendation to just stay with Medicare. Just because of that. That’s what insurance is. Right. That that unknown component of do you want it to wipe out your savings or your retirement, you know, for, for not paying a little bit monthly or just having, you know, the advantage plan, worst case, to give you that protection.

Betty Wang 00:25:11 Do you help them with the supplemental plan we do or how does that work?

Julia Wiswell 00:25:15 So the supplemental plans are offered by insurance companies. So that is something that we we contract with those carriers and offer those particular supplemental plans.

Betty Wang 00:25:24 So the supplemental plans aren’t from directly from the Medicare.

Julia Wiswell 00:25:29 Correct. Yeah. Those are from insurance companies such as. Yeah. All the carriers will offer a supplemental plan.

Betty Wang 00:25:36 That makes more sense.

Julia Wiswell 00:25:40 Even more even more info and more plans to digest.

Betty Wang 00:25:43 Right? It’s really I think it’s really overwhelming for people. Typically, how many meetings do you have with clients when you’re trying to work through this? For them?

Julia Wiswell 00:25:53 1 to 3 meetings is pretty typical.

Julia Wiswell 00:25:55 You know, it just depends on that particular client. If somebody is just super low maintenance, they don’t want to necessarily dive to, you know, to into plans and into detail and what’s important to them. You know, sometimes they’re on meeting one. They’re like, yeah, makes sense. Let’s enroll. Good to go. But you know, a lot of a lot of times I would say two meetings is is very typical for us. We have the initial consultation of just breaking down all of this information, going through costs, going through plans, going through prescriptions, doctors. And then, you know, we kind of summarize that in an email they digest. And then we usually get back together, you know, in about a week or 1 to 3 weeks or so, depending on how much time we have before their deadline to enroll. And then that’s when we move forward and do an enrollment.

Betty Wang 00:26:44 Open enrollment is every, every fall, right? So do you recommend that people come to you every fall? It’s not I mean, I think most people are used to having their employers say it’s open enrollment.

Betty Wang 00:26:56 And if you don’t do anything, your insurance just kind of rolls over. How does that work once you’re retired? Is it similar or is it different?

Julia Wiswell 00:27:04 Very similar. You know, no action required from for the most part, unless a carrier is discontinuing a plan, which is typically pretty rare. But for the most part it is a very seamless rollover. Just like you mentioned on the employer side, it’s no change means that you’re just rolling over. And so, you know, these plans change some each year, you know, with updates and different copay amounts changing. I would say the network change is very low. There’s not a lot of network change and fluctuation in that. So if someone is wanting to change, It’s most likely due to the benefits. But every now and then, of course, there’s a doctor that drops out of network that we have to change. Or maybe a carrier loses a contract with a hospital system. And so, you know, I would say we send out an email to our clients, usually mid September, that says, hey, open enrollment is approaching.

Julia Wiswell 00:27:53 We can legally talk about the plans for the following year, October 1st. So that’s kind of when we start our process of how is your plan this year? Do you want to make changes? And so that’s kind of our process in our office for our clients. And you know, a lot of times people are like it’s been working great or, you know, haven’t maybe they haven’t used it. And so it’s not necessarily on their on their mind to make any big changes. And so yeah that’ll just roll over for most carriers.

Betty Wang 00:28:18 Well historically I think we as advisors have been told your client should look at it every year, especially for the drug coverage, because they change the formularies and what they’ll cover. I guess that’s less of an issue now that there is a cap.

Julia Wiswell 00:28:34 Yeah, I would say so. I mean, you know, every now and then there’s maybe a carrier that drops, you know, it seems like this last year was it was an inhaler that a lot of carriers weren’t wanting to cover.

Julia Wiswell 00:28:45 And so, you know, that does create of course, needing to look at it. There’s getting a notice that says, hey, come the following year, we’re not covering this prescription.

Betty Wang 00:28:52 And so so clients can expect a notice from that.

Julia Wiswell 00:28:56 Absolutely. Yeah. They are notified.

Betty Wang 00:28:58 Okay. It’s not like they have to go digging to find. This is what I know that I take. Correct. Is it covered. And the same with doctors. Will they be notified if a doctor or a hospital system is getting dropped from their network?

Julia Wiswell 00:29:12 They will. Yes. If that particular physician that they’ve been seeing or facility and they have that insurance and they’re dropping, they will be notified. Yes, it’s a bigger scale. You know, a provider losing a big hospital system that’s also very well known to US brokers in the industry. You know, carrier has now not working with this hospital system. But as far as doctors, you know that that’s not something that we necessarily know.

Betty Wang 00:29:39 Until the next year.

Julia Wiswell 00:29:41 Yeah. And so our clients are kind of coming and saying, hey, this you know, doctor that I’ve been seeing is no longer accepting this plan. But I’d say it’s, it’s very few and far between that that happens.

Betty Wang 00:29:51 What are some common or mistakes that you see people making when they’re choosing their plan or. I don’t know what what kind of things do you see? I’m sure you’ve seen some a lot of things.

Julia Wiswell 00:30:03 Yeah. You know, I would say sometimes I come across people that should probably be on a supplemental plan, and maybe they chose the advantage plan. And, you know, sometimes they feel that they’re mostly coming to me because they have an issue and that issues that there’s maybe network restricted. And, you know, they had a pre-existing condition such as cancer. And so that makes it challenging for them to be able, you know, to get on a supplemental plan because of the underwriting component now. So sometimes you know something that we’ll see. The the advantage plans can be very enticing because of the the zero monthly premium.

Julia Wiswell 00:30:39 But just like anything, it’s not always the best choice for somebody. So, you know, it really depends on, on their medical history and, and how much care, access to care they’re looking for. But generally, I mean, you don’t see a lot of things that can’t be switched, you know, to, to help them get better coverage, whether it’s their prescription is just costing too much in a different carrier is covering it better. You know, that’s something we can always switch. So for the most part, you know, we don’t come across people that are just in a really tough spot. I mean, you know, even if they enroll late, the rules have changed around that a little bit. So even if they didn’t enroll in Medicare when they should have, they still have the ability to pick it up the following month. So, you know, things have changed to become a little more flexible, which is nice. So people aren’t, you know, in a position where they’re uninsured for a long period of time.

Betty Wang 00:31:32 Can I talk about the current rules just because they are always changing?

Julia Wiswell 00:31:36 Yes. So if somebody didn’t enroll in Medicare when they should have, when they turned 65 or when they lost employer coverage. And and to be clear, in this situation, if somebody did that, they are uninsured, unless for some reason they have some other insurance. But in this scenario, if somebody just didn’t get insured, you know, one, they don’t have insurance too. Now they can apply in any month in Medicare would take effect the first of the next month. So somebody is applying in January. Their Medicare would take effect February 1st where before it was you know, only can only do that from January through March was the only time you could apply. So somebody from from April through December, you’re having to wait that whole next year before you can apply. So now it’s a little more flexible. We don’t come across a lot of people in this situation again, because you’re uninsured. Most people, right, don’t want to be uninsured.

Julia Wiswell 00:32:29 So I can’t say that this is something that I’ve personally come across very often, that people are just, you know, they’re 67. They’re like, oh, I guess I should have gotten Medicare two years ago. But but not, you know, it it does happen. But those, at least for those people now it’s a lot more flexible that they can pick it up.

Betty Wang 00:32:47 But their costs are higher.

Julia Wiswell 00:32:49 Their costs are going to be higher if they don’t pick it up. Specifically Medicare Part B when they’re first eligible, they will have a 10% penalty. And that penalty is assessed for life. It never goes away. So it accrues. It’s basically a compounding penalty. So the longer they go uninsured, the higher that penalty is. And so yeah it can get it can get pretty pretty costly for somebody that just chooses to not enroll in Medicare when they’re eligible.

Betty Wang 00:33:14 And something that I talk about with my clients when we’re doing tax planning and planning for retirement is Irma. Can you talk a little bit about that and how that works?

Julia Wiswell 00:33:24 Yes.

Julia Wiswell 00:33:24 This is somebody like like yourself where you guys, you know, we work with advisors and, you know, kind of planning for that if you’re able to. Great. And some people are just in a position where, you know, financially they have to do what they have to do. But because we also do under 65 insurance. So we have we come across a lot of people that retire early. And I would say that’s, you know, 58 to between 58 and 65. So, you know, if we have that relationship with that client and we’re saying, all right, you know, you’re 60 now, you have a financial advisor that you work with. You’re going to retire. You know, we should bring that financial advisor into the conversation and say, you know, Medicare does a two year lookback period on your income. And the higher your income, the higher your Medicare Part B premium and your Medicare Part D drug prescription drug plan premium goes up. And so if that client is in a position with the advisor that you guys can, you know, make their income within a bracket that feels comfortable for them to pay monthly.

Julia Wiswell 00:34:27 That’s you know, that’s definitely something we, we work with. And so yeah, a lot of times bringing that factor in, a lot of people are unaware that Medicare is based on your income. And from two years ago. So somebody that sells a house or has a large inheritance, you know, those are things that you’ll get charged more for. There is a form that they can fill out. And I would say that this success rate is probably I would say it’s pretty high in my personal experience for my clients that says, you know, one, if you have a it’s basically a qualifying life event form. Did you retire? Did you lose a pension? do you know any sort of loss of income that puts you in a in a lower bracket to pay less, though the Social Security office is the one that processes those forms. So look at that and say, all right. Yeah, this circumstance warrants paying less monthly. And so that’s always an option to.

Betty Wang 00:35:21 And from my experience too with clients like when they’ve retired we’ve submitted this form and it’s usually been accepted.

Julia Wiswell 00:35:28 Good. Yeah.

Betty Wang 00:35:29 Which is great because it lowers their premiums. Where exactly does the Irma dollars go? Do they go toward paying for. It’s just a premium. And they still have to pay a part B premium in a part C. Like do they have to pay the supplemental premiums too? Is that how that works?

Julia Wiswell 00:35:49 Yeah. So that Irma is simply for part B and for part D. And so there is no Irma on a supplemental plan. So if somebody is in an Irma situation, they are not going to pay extra for a supplemental plan. So the supplemental plan is a fixed rate based on, you know, demographics, age and where they live now. They would still pay the Irma even if they roll enroll in a Medicare advantage plan. So that, you know, even though the premiums for the most part are $0, they would still pay the Irma on part B and D because they have a prescription drug plan. Thank you. Yes.

Betty Wang 00:36:24 What about folks who are just trying to help their parents or an elderly loved one through this.

Betty Wang 00:36:29 What recommendations do you have for them?

Julia Wiswell 00:36:32 Yes, we come across this. The power of attorney is a big thing. You know, making sure that that child or family member has the ability, you know, what abilities do they have? Can they sign an enrollment on their behalf? You know, it just depends on, I guess, the health of that particular parent. But we do work a lot with mostly the, the children of of a Medicare eligible client. But, you know, we have the same types of conversations. And, you know, again, just digesting it all and, you know, talking with their parent and, you know, maybe that person is helping financially too. So that is another factor that that comes into play as well. Yeah, definitely all the same things to think about.

Betty Wang 00:37:13 Okay. Well thank you I feel like there’s more to to dig into. But I don’t want to keep you all day.

Julia Wiswell 00:37:20 No. You’re good.

Betty Wang 00:37:21 I always sort of end my my podcast with two questions for for my guests.

Betty Wang 00:37:27 And it’s just with your busy schedule, because most of my listeners are women who are, you know, my age or older. How do you maintain the balance in your life with your own business, working in it and growing it? And you also have children too. Like, what do you do to keep your balance in peace?

Julia Wiswell 00:37:49 That’s a great question. I like to work out in the morning. That’s my big thing. I feel like I get relief. It’s it’s great for me. So I enjoy that. I’m not always great about this, but I want to be better. I do like to go for afternoon walks. And so my husband and I, you know, work together. And so we’ll usually after lunch, it’s like just a quick neighborhood 20 minute walk. And that just rejuvenates you. You know, whether you’re we’re sitting at the desk all day, we’re on the phone all day. And so just just getting out and getting fresh air and just feels great. So I want to be better about that, but I do I do love when we do that.

Julia Wiswell 00:38:24 And then I love reading, you know, whether it’s, you know, business, inspirational books or just just a fun book. It’s just fun to to escape. It’s hard. I mean, I’m not TV is a is a lot of time for me. So I’m not a big TV person. But so yeah, those are kind of some of the things I do to.

Betty Wang 00:38:41 Decompress.

Julia Wiswell 00:38:42 Get through the day. Yes.

Betty Wang 00:38:43 What do you have any book recommendations? I’m a big reader. Anything you’ve read recently? I read all genres, so yes.

Julia Wiswell 00:38:51 Okay, I love that. So I just read Blue Sisters.

Betty Wang 00:38:54 Oh, I haven’t heard about that. Okay.

Julia Wiswell 00:38:56 That was a good book. Yeah. That’s it. I think it’s a newer one, you know. So I’m kind of late to the game, but I’m starting to read Atomic Habits. I know that was like a really? Yeah. I mean, I’m in the middle of that and enjoying that, but just trying to do a balance of both, you know, little fun, little motivational stuff.

Betty Wang 00:39:15 Yeah. No, I go back to Atomic habits every once in a while because you forget. You forget. You get into your own life again. Yeah. And then, I mean, you sort of talked about your hobbies just because in retirement it’s found that when you have something that you enjoy doing, you love doing that you have a passion that you’re generally happier and more content in retirement. So I’m always shopping for what people do as interests in their free time.

Julia Wiswell 00:39:43 So have you ever played pickleball?

Betty Wang 00:39:44 I have, yes.

Julia Wiswell 00:39:48 Yeah. Not into it.

Betty Wang 00:39:50 I do, I like it a lot. I just sometimes I, I don’t know, I feel like I might get injured, but yes, that is the new biggest thing. It’s fun.

Julia Wiswell 00:40:00 Yeah. I grew up playing tennis and ping pong and so anything racket, sport, badminton, I, I love. So like, in the summer, my husband and I will go down to the rec center and play. But the older generation is very good, let me tell you.

Julia Wiswell 00:40:17 They have mastered the spin and not having to move around as much where I feel like I’m, like, running the court, you know? But yeah, we enjoy that. We enjoy playing pickleball.

Betty Wang 00:40:28 That’s fun. Yeah. I mean, I get confused with. Are you in the kitchen? Are you not in the kitchen like I. Yes. Yeah. It’s amazing that they’re coming up with new, new games and.

Julia Wiswell 00:40:39 It’s so fun. Yeah, we we enjoy that.

Betty Wang 00:40:41 Do you like being partners on the pickleball court or do you play against each other?

Julia Wiswell 00:40:46 We are mostly partners. I think I enjoy doubles more than singles, but it’s just running around too. But but I think there’s more of a strategy. And my husband’s tall and.

Betty Wang 00:40:56 Oh, you just put him in front, I don’t know.

Julia Wiswell 00:40:59 Yeah, exactly. Sounds like picking up the back the back court. And he’s up to up in front. And so yeah, we yeah, we have fun. It’s it’s good time.

Betty Wang 00:41:08 Wow. I mean, you must be really great. A great match if you work well, you work all day together and then you go play pickleball together. I mean, I know of couples who play pickleball together. Being partners would break up their marriage, right?

Julia Wiswell 00:41:24 It is. It’s so true. Like, there are different spectrums to that. Yeah. We are together all day, every day. And it works great. We have. Yeah, really it’s great. Like with the kids, we can be flexible and be there for them. And yeah, we we enjoy it. But we know it’s there’s a lot of couples that we hear that from. They’re like, I could never I could never.

Betty Wang 00:41:48 Yes. Is there anything else you want to share that we didn’t maybe cover about Medicare?

Julia Wiswell 00:41:53 You know, just our website is was wal insurance.com like our last name. And we use that for our resource for all of our clients. We we update it. You know we pretty often. So we put like new information there.

Julia Wiswell 00:42:08 You can schedule a call with us. So that’s definitely a good resource to get in touch with us. And you know updates on what’s happening in the market, whether it’s Medicare or under 65. All of it tend to keep that pretty up to date. So that’s the best way to find me.

Betty Wang 00:42:22 Okay, well, thank you so much for your time.

Julia Wiswell 00:42:25 Of course. Thank you. Thanks for having me. This is great.

Betty Wang 00:42:29 Thank you for tuning in to another episode of Betty Smart Friends. I hope you enjoyed today’s conversation and that you learned something new. You can connect with us on social media to stay updated on future episodes. Share your thoughts, and join our community of smart friends. You can find us on Instagram at Betty Financial. And don’t forget to subscribe to the podcast so you never miss an episode! If you are feeling ready to be more empowered and less alone in your financial life, please schedule a complimentary 15 minutes with me. The link is in the show notes. Please see the show notes for important disclosures regarding BW financial planning and this episode.

Betty Wang 00:43:12 Until next time, remember you are not alone. We got you.