WEBVTT
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This program is designed to provide general information with regards
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to the subject matters covered. This information is given with
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the understanding that neither the hosts, guests, sponsors, or station
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are engaged in rendering any specific and personal medical, financial, legal, counseling,
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professional service, or any advice.
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You should seek the services.
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Of competent professionals before applying or trying any suggested ideas.
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Attention to individuals, families and caregivers. It's Medicare Hour and
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More with Peter right here on k for HD Radio.
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This is the podcast for all types of insurance solutions
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while specializing in Medicare because we Medicare.
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Here's your host, Peter R.
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Joseph. Good morning, good morning, good morning. I'm so glad
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to see all of you, guys. It is episode five
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of our radio show. I can't believe he already in April.
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It's crazy. This time is just flying by. I hope
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you had all a wonderful, wonderful easter and spring break
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for those of you have kids and families. And yeah,
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our family actually went out to Disneyland for a couple
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of days. It was very crowded. I'm not sure it
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used to be so fun and now, it's just it's overcrowded.
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It was definitely hot, and a lot of the rides
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broke down, so it wasn't the greatest experience. But my
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kids had a good time, so that's all that matters.
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But anyways, we've got a great show today. We've got
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a special guest. Her name is Missy Bolt. She's a
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CEO of Medicare Misty, so we'll see her in a
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few minutes here, but we will continue on our conversation
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breaking down Medicare for you guys, making it simple. We've
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covered Medicare Parts A, B, C and D. We've covered
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the different enrollment periods for Medicare, when you're supposed to
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sign up, how you're supposed to sign up. So hopefully
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you caught all those tidbits of knowledge and information and
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it's been helpful and you've been able to apply it
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to yourselves. We are going to dive more into Medicare
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Parts C. We did start talking about it a little
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bit this last week. We're going to continue talking about
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that today if we have time, and then we'll have
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our great interview and conversation with Misty talking about the
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Medicare trends and things happening in this space that might
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be concerning I might be needing some of our attention.
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There's definitely going to be some more disruption for this
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next year with Medicare again unfortunately, and so you know,
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this is kind of the time where plans are starting
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to shut down, PPOs aren't as prevalent, and if it's
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our getting cut unfortunately left and right, that doesn't mean
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there's ways around that. We're going to talk about how
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to navigate all of that. So all right, so let's
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dive into Medicare Part C and then we'll wait until
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Misty comes on board and then we'll jump into our
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interview with her. So we had talked about how Part
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C is the Medicare Advantage plan space, and so that
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is where it includes your Part AB and then d
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IS and DOG for your prescriptions. It's all in one versus.
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Remember Medicare Supplement we talked about was like an all
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a kart system, so you have to figure out also
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budget wise, Medicare advantage usually doesn't cost anything extra. However,
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Medicare Supplement does have an extra premium, so budget wise,
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you have to figure out what is best for you
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and what you can afford so that's why a lot
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of folks do go the route of Medicare parts see,
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because there is no extra premium that you have to pay,
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and it also includes your extra benefits usually of dental, vision, hearing,
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over the counter allowance, transportation, all those necessities that you
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might want that's not going to be included in a
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Medicare supplement And so that's kind of the key that
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we want to focus in on. The bad thing about
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Medicare advantage is that you are stuck in a HMO network.
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There are PPO plans, not as many as there used
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to be, but you are, you know, in a network.
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There is coordinated care. That's the strong suit. But with
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a Medicare supplement plan, you're able to see whatever doctor
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you want without any authorization. With the HMO plan, you
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have to usually go through your primary care doctor to
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see a specialist. So that's the big difference, and so
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people like to have that freedom, but you pay for
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what you get, right, So we're going to continue talking
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about the different extra benefits that there are though, So,
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like I said, there's vision, hearing, gym membership. Gym membership
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is included also on the supplement side, over the counter allowance.
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It just ranges from planning to plan. Sometimes it's about
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twenty five dollars a quarter. Sometimes it goes up to
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one hundred dollars a quarter. It just depends on the plan.
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But you can use that for the pharmacy section, anything
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that's in there, like band aids, vitamin supplements. Most carriers
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will send you a catalog of what you can get. Transportation,
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usually it's coordinated through uber or Lyft. Some carriers do
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have their own services as well. And the meal programs
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after hospital stays are surgical procedures, So those are the
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extra benefits. And then again we said it does include
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prescription party and then the coordinated care. It's especially strong
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with HMOs. Doctors communicate within the network, so you've got
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that advantage as well on the Medicare advantage side. So
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the difference again with HMO is you can stay in
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network PPO you can go in or out of network.
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But like I said earlier, PPOs are not as prevalent.
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There's not a lot of choices out there, especially in
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southern California. It's just it hasn't been beneficial for the
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insurance carriers and that's why a lot of them have
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shut them down, so just keep that in mind. And
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then we briefly talked about special needs plans. Those are
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for chronic conditions like diabetes, heart conditions, lung conditions like COPD.
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So those plans are adapted to those chronic illnesses and
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it's just more coordination, better coordination for those illnesses. So
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that's why you want to be on those plans, especially
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with the prescription drugs that you would be taking if
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you're on one of those illnesses. All right, So the
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key benefits of medicare advantage. You've got lower monthly premiums.
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Like I said, a lot of them are zero dollars,
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especially out here in California. The maximum out of pocket
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that you would spend, Remember that's different from a deductible,
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So maximum out of pocket here in California, I mean
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it's low. It's about two hundred to eight hundred dollars
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max on most plans out here. And that's the most
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you would ever spend. God forbid if something happens to you,
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you know, cancer, chemotherapy, those kind of things. So that's
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the most you would pay out of pocket. You do
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have to alsways pay your part B premium. That's that's
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never going to go away. A lot of my clients think, oh,
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I'm a Medica it's free. It's not free. Medicare Part B.
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You're paying a premium right now. It's about two oh
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two for most folks per month, two hundred and two dollars.
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And we do pay into Medicare, but we pay into
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it so that we keep the premiums low. It's not
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so that we can have Medicare for free. So just
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keep that in mind. The Medicare is not free. Again,
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the maximumount of pocket protection once you reach it, the
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plan that you're on for Medicare Advantage pays one hundred
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percent and then you know you've got those extra benefits
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as well. Now, let's evaluate real quick the prior authorization process,
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because there are potential interventions to reduce unnecessary initial denials.
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That's what a lot of people are scared of when
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they go on Medica Advantage. They feel like they're not
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going to get proved for procedures, they're not gonna be
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able to see certain doctors because they're not in network,
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and they're afraid that their claims will be denied. So
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I will tell you from my experience, a lot of
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my clients are happy with the carriers that they're on.
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Because of my experience, I know which ones work well
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with each other, which ones have a quick turnaround for authorizations.
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So you have to get with an agent like myself
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that's specially knowledgeable about the carriers and their procedures. Okay.
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So there's instances where the provider orders imaging and then
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there's a prior authorization required okay, and then it's either
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approved or denied. If it's approved, the imaging is performed
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and then you go see your doctor or you go
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over your results. If it's denied, it's called what's a
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peer to peer required There is an appeal process, but
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a lot of times if you're seeenior primary care doctor,
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pretty often these cases aren't going to be denied. You
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just want to assess documation patterns for opportunities to reduce
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risk for denial.
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Okay.
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Your doctors are pretty knowledgeable about how to navigate that
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system as well. You know, you want to streamline the workflow,
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ensure that doctors are putting in the right reasons for
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you getting that imaging or those tests, and if they're
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connected to, you know, something that you've been diagnosed with
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that's a greater chance of that being approved. So just
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keep that process in mind. Now, the generosity of Medicare
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advantage compared to traditional Medicare, there's a difference between the
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monthly out of pocket costs and traditional Medicare versus Medicare advantage.
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So if you're just on original Medicare, let's say you
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sign up, you turn sixty five, you're just on Medicare,
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and you pick up a part dy for your prescription
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drug coverage. There is no ceiling to the max out
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of pocket costs when you're on original Medicare. That's why
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folks get onto a private plan through Medicare advantage or
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through Medicare supplement is to mitigate those costs and make
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sure that there is a ceiling. So again, keep that
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in mind that there is no ceiling. If you're just
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on original Medicare, they pay eighty percent and then you're
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responsible for twenty percent of the total costs. So you know,
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if you've got a bill for one hundred thousand dollars,
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you're going to owe twenty thousand dollars on that bill,
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all right, So just keep that in mind. Again. Here's
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the here's the other pitfalls versus original Medicare and Medicare supplements.
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If you're on a Medicare advantage, again, you're not outside
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of network unless it's an emergency through urgent care or
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through an emergency room facility. Otherwise you cannot go outside
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of network for your specialists, for any doctors, ongoing treatment
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and cancer care continuity, all those have to be in network,
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all right, So there are network restrictions. That's a big
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issue when clients move or travel, especially if you have
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family in other states and you want to stay there,
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let's say for six months out of the year. You know,
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my suggestion would be to go on a Medicare supplement
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versus Medicare advantage. That way you're able to see other
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doctors in other states. So that's a reason to go
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the route of a Medicare supplement over a Medicare advantage. Again,
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there's prior authorizations, so you know, many services require approval,
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MRIs require approval, surgeries require approval, certain medications require prior authorization.
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And then sometimes you know, folks will run into delays
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and care, which is a major frustration point. You know,
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the way times across the board right now, our health
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sector is very impacted and understaffed, and so we're hearing
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stories of people not able to see their primary care
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doctors for three or four months at a time. They'll
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call in and they can't get an appointment until three
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months ahead of time. So that is a concern, and
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so another way around that is to try to get
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on a supplement plan, see another doctor as an alternative,
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and get in to see that doctor quicker. So again,
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though there is an extra cost to a Medicare supplement.
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The other thing that happens is plan changes every year,
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so benefits, networks, formularies change annually. Doctors and hospitals can
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be dropped, plans exit and enter the market, and so
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there's frustrations on that part. That's why we review with
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our clients our Medicare advantage planes every year to make sure,
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you know, the benefits are staying the same, if they're
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increasing or decreasing, their doctors are still staying in network,
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you know, and if they don't or there's issues with
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certain prescriptions, then we have to navigate and figure out
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a different carrier that a client has to be with.
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And that annual rollment period again is every year October
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through December, So yeah, there is a headache about doing
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stuff like that. I'm going to stop there. See if
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Misty is with us or not. I don't know if
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she's hopped on. Hopefully she has. All right, Well, I'm
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going to at least do an intro for her. Nope,
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she's not on yet, Okay, So I'm going to just
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share real quick about Misty. Maybe by the time I
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finish this she will come on. If not, that's okay.
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So Misty Bolt is the founder of Medicare Misty. She
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has over twenty five years experience in the insurance industry.
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Her focus is navigating the Medicare mais, including original Medicare
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and Medicare Advantage, medigap, and party prescription drug plans. Her
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services are enrollment assistants, plan comparisons, educational events like insurance
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book camps. She is located on the East Coast. She
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is in Tennessee, so she primarily works out on the
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East Coast. But she does you know, she has licensed
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in forty five states. In Puerto Rico, she does have
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fifty five agents under her belt. How did I meet
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Missy while? We met actually through social media. So social
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media is a powerful tool obviously where we can meet
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our colleagues and peers in this industry. And so that's
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how Missy and I have met. I've known Misty for
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quite a while. She authored the book Navigating the Medicare
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mais with Medicare Misty. Probably find that book on Amazon again.
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That book is called Navigating the Medicare Made with Medicare Misty,
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and that was to help provide guidance on healthcare options.
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She also authored a children's book that comes out this may,
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so be on the lookout for that. She has her