Medicare You Choose … Sort Of (Medicare Part B)
Announcer: Welcome to our fireside chat with Seniors Living Healthy, the podcast that helps prepare and educate you as you enter and live out your golden years. With over 10 years of experience, Nick and Zach are experts in the senior market and are here to help you live a healthy, full life. And now fireside with your hosts Nick and Zach.
Zach: Hello, and welcome to episode two of our inaugural season of Seniors Living Healthy. Again, I’m your host Zach, and here with me is my co-host, Nick.
Nick: Hello. Hi folks.
Zach: This episode, we’re going to go over Part B of Medicare which covers your outpatient care. So again, as I’m sure that you’ve guessed, this episode’s ABC of Medicare is going to be Part B, medical. So, once you turn 65, you’re going to be able to elect to take this Part B as long as you don’t have credible coverage, Nick, tell them what the government considers credible coverage.
Nick: Credible coverage is determined by the level of coverage offered under the plan, and the number of employees covered by that plan. Among other things, if you are turning 65, or intend to retire soon, reach out to your HR benefits department to see if you will have credible coverage when the time comes.
Zach: That’s great, Nick. And so if they don’t have that credible coverage though, and they don’t take their Part B, and pass on it, why don’t you tell them what they’re going to win by not having that credible coverage?
Nick: Yeah, absolutely. Okay. So, once an individual goes eight months after they stop working, or employer coverage ends, whichever is first. They will be penalized by Medicare and that penalty is 10% of the full cost of the standard Part B premium, each year they go without coverage. Also, after that timeframe, there is a limited window, Zach, that a person can apply for Medicare benefits. It’s what’s called the general election period. It typically runs January 1 through March 31, with coverage beginning in July of that year.
Zach: Gotcha. So, they let you elect it, kind of, sort of—
Nick: On their timeframe. Yeah, you got it.
Zach: Yep. Yeah. So, they tell you you don’t have to take Part when you turn 65, but if you’re not covered, you kind of have to. So, now that we’ve covered how you get your Part B, what all is that Part B going to cover for you once you receive it?
Nick: Yeah, so Part B is outpatient coverage. So, folks, you can think of Part B as covering everything outside of being admitted to the hospital. So, meaning any type of services outside the hospital that are medically or Medicare-approved are covered under Part B. Some of those common services, Zach, we see things like doctor’s visits, whether primary care or specialist—
Zach: We’re going to have to have a referral to see those specialists though?
Nick: Oh, great question. We hear that quite frequently. Medicare has no referrals. Absolutely. Lab work, physical therapy, CAT scans, MRIs, ambulance rides, emergency room visits if not admitted to the hospital, and homecare in limited basis, are all covered under Part B.
Zach: Great, great. So, now we know what they cover. We had that deductible on Part A we talked about last episode. Is it similar here with Part B or, kind of, how—what are they going to cover for us?
Nick: So yeah, great question, Zach. Medicare Part B has an 80/20 coinsurance, meaning Medicare pays the first 80% and you’re responsible for the remaining 20%. The coinsurance takes effect after you have paid an annual deductible of $198 per year. Once the deductible is paid in full, you’re responsible for 20% of all remaining charges. And remember, just like Part A, Part B is a nationwide program designed for Medicare beneficiaries; no networks associated, and just like you said, no referrals necessary.
Zach: Great, great. So, as we know from last month’s episode that Part A, we paid into when we were working. So, Part B, we elect to take it, we haven’t paid anything to it, yet. Nothing in life is free. How are we going to get that covered?
Nick: Yeah, so absolutely. So, you’re right. Nothing in life is free. This is a topic we run into quite frequently. One of the first questions people ask is, “What’s it going to cost? I’m new to Medicare, what’s it going to cost?” So, the answer is very simple: it differs. There is a standard Part B premium, that is $144.60 for the year 2020, however, the amount people pay varies widely. Some individuals pay nothing for Part B, some individuals pay the standard premium, and people making over $500,000 a year actually are paying $491.60 per month, Zach, so it varies quite differently. Most of these premiums begin the first month your Medicare goes into effect, and reach out to your local social security office to figure out what your Part B will cost you if that’s something you’re worried about today.
Zach: Gotcha, that’s great. So, I know we talked about the quick overview of what all Part B is going to cover, hit some highlights there, but I know there’s a few things out there that Part B covers that not a lot of people know, or people use them on a daily basis and knowing that Part B is going to cover that’s going to be a huge help for them. You want to run through those for us real quick?
Nick: Sure. So, the two common services that there are a lot of confusion about what are where it’s covered are durable medical equipment and diabetic testing supplies. I know you and your clients, Zach, you’ve been doing this for a number of years, this is a question we get asked all the time. “Who pays for my diabetic testing supplies? Who pays for my strips, et cetera?”
Very simply, Part B of Medicare pays for diabetic testing supplies. Insulin, pills, diabetic medications are covered under Medicare Part D, but the testing supplies themselves, folks, are covered under Medicare Part B. And then the other one there, Zach, is durable medical equipment. So, that’s nebulizers, oxygen tanks, wheelchairs, crutches, you name it. All the medical equipment is also covered under Part B, meaning after the $198 deductible is met, clients are responsible for 20% of all those costs.
Zach: Definitely, yep. That’s a big part there with that Part B, what all it covers, especially those diabetic testing supplies. That is probably one of our top two or three questions we do get.
Nick: Absolutely, absolutely. So, in a nutshell, that’s Part B.
Zach: Hello, and welcome back. We’re here on the phone with Dr. Sara with Freedom Chiropractic here in Knoxville. How are you doing today, Dr. Sara?
Dr. Sara: I’m doing wonderful. Thanks for having me on.
Zach: That’s good. Thank you so much for joining us. Like I say, we’re going to jump on in here with our interview part of our segment. And so we have Nick, as well, is here with me, so he’s going to get the ball rolling for us.
Nick: Sure, absolutely. So, we’ll jump right in Dr. Sara. So, first of all, our first question for you would be what does Medicare cover when it comes to chiropractic care?
Dr. Sara: Yeah, that is the favorite question from everybody, which is amazing. Medicare is actually a pretty favorable insurance when it comes to chiropractic coverage. While a lot of times, within our world, chiropractic is a little bit more of a preventative focus, and so it can be less length of time to which they will cover stuff in some instances, but typically, if somebody would come into our office, the only thing that is not covered within Medicare is going to be any examinations and/or X-rays if those are taken. But otherwise, actual chiropractic service can have some really decent coverage with that.
In our current office, we do a complimentary benefits check to make sure to see what is actually covered, if there’s any supplementals, and if there’s anything extra we need to know about that specific client. So, we would do all that, and before we—at least for us specifically, we’d let everybody know what that insurance coverage is for the length and period of time that they would be under our care, prior to them actually getting adjusted.
Nick: Very good. Very good. And just a quick follow up on that. Dr. Sara. In general, are referrals needed for individuals with Medicare?
Dr. Sara: No, they typically are not. At least for us, we have a lot of people that are calling in from either just, like, family referrals, or a doctor is recommending a chiropractor, or physical therapist is recommending one, but also just a lot of people are just looking for another option. And so yeah, it does not need a referral, but if you have friends and family that are interested in chiropractic care, we would love to definitely take care of them.
Zach: How can chiropractic care help you live a healthier lifestyle?
Dr. Sara: So, I just want to talk a little bit about just, like, what chiropractic is, and how the body works a little bit to explain that question. So, the way that our bodies work, your brain and your spinal cord control and coordinate every single function in your body, and it does so from the top of your brain down to the rest of your system out through those nerves to every single cell, tissue, organ within your body. And so, over the course of our life, we have this crazy thing called stress happen. We’re all in a season of incredible stress, currently. And just within that type of stress, your body has to do something with it.
And so what can happen with those bones within your spine, it actually can shift them out of alignment. And so when they’re out of alignment, it can cause pressure, irritation, even damage to the nerves that are then trailing to the rest of your system. And so not only can you have pain, but you can also have organ dysfunction. So, we have a lot of people that do have a lot of reoccurring chronic pain and or acute pain, while at the same time have organ dysfunction, like digestive issues, or thyroid issues, or sleep dysfunction. And a lot of those types of things, they don’t really necessarily think chiropractic can help, but—so the cool part is we are removing that pressure, and putting those bones back in the proper place, it allows your brain and your body to connect and actually function optimally, and as that happens, for one, a person gets out discomfort while at the same time that means that organ system is also thriving and starting to optimally function.
So, if you’re not in as much pain, it also gives you an opportunity to live your life and to do the things you want to do. I have people that have goals that they just want to pick up their grandbabies, and play around, and go travel, and do all these fun things without being in as much pain as they were in. So, that’s our hope is that we can get people to that stage and actually see them have that type of change within their health.
Zach: Kind of following that one up, as we know, you do a little bit, not your traditional chiropractic care.
Dr. Sara: Yeah.
Zach: Kind of explain what you guys do over there at Freedom Chiropractic that’s different than a lot of other chiropractic places.
Dr. Sara: So, a lot of times, chiropractic is presumed to be a manual type of an adjustment where the practitioner is using their hands to actually physically move a bone back into place, and I am definitely on the pro side of all chiropractic works, 100 percent. I am a proponent for having people definitely find what jives with them. We are very different. We’d actually don’t use our hands to adjust, we use a technique called Torque Release Technique that allows us to be able to assess the actual nervous system, and then we use a small handheld tool called an integrator to actually administer the adjustment.
And so the beautiful part about that is it allows us to be incredibly specific. It is FDA approved, the tool that we use actually adjusts at one ten-thousandth of a second, so it’s really fast while it’s also incredibly gentle. So currently, in our office, our, actually, oldest practice member is actually 93 years old, and we get to be able to use this technique where it’s not going to be hurting anybody; it’s really gentle, but at the same time, it’s really specific to the actual stress that spine is carrying. Yeah, it’s definitely different, but at the same time, all chiropractic does work, for sure.
Nick: Okay, great. Well, the next question that I would have for you is, is it ever too late to start care? I mean, this flows great with the fact you said you’re, I think, your oldest client currently is 93 years old, does that timespan ever run out?
Dr. Sara: No. I think the only limiting factor that’s going to run out—or potentially put a hindrance on somebody is whether or not they can get to the office. That’s pretty much the only thing that’s going to keep us from potentially being able to see them. But I mean, I’ve gotten to people’s homes before, if it ever works to be able to do that, I’ve gone to a hospital before.
So, situations like that can happen. But I always joke with people, if you have breath in your lungs, you can get adjusted, basically. Because, ultimately, if you have breath in your lungs, it means that you have a nervous system that is still functioning. And the gentleman that I mentioned that’s 93 currently, he actually started with me when he was 85 years old, and so he’s been under care for the past seven years.
He still golfs three times a week, does 18 holes. He came in the other day and was like, “I’m a little tired after golfing 18 holes.” I’m like, “I’d be tired if I golfed 18 holes, and I’m in my 30’s.” So, in the same sense, our hope and goal no matter the age or no matter how young we are is to be able to provide opportunities so that we can thrive within that age, within the body that we were given, for sure. So, definitely not too old. The older we get, unfortunately, life does continue to build and stress continues to have. So, we would rather have people get going no matter when, but never too late for sure.
Zach: That’s one of our sayings around here is, unfortunately, don’t get healthier the older we get. That’s for sure.
Dr. Sara: Yeah, that’s true. That’s very, very true.
Zach: And so, our goal of our podcast, as we’ve talked about, is helping people prepare for retirement, whether that be 65, 70, 75 whenever that is. What are some tips you may give to some of these people who listen to this podcast that are getting ready to go into retirement? They’ve been sitting in a desk nine to five every day or longer, and now all of a sudden, they’re not going to be sitting at a desk, they’re going to be able—they might go out and play golf three times a week. They’re going to be out doing some different things. What are some tips to keep in mind while preparing for retirement health-wise?
Dr. Sara: Yeah. Just like you, I talk all the time to my people, if you get up into retirement age, and you have all the money in the world, and you want to travel, you want to do all the things you want to do, yet you don’t have your health, what do you have? And that’s such a big thing when it comes to our health because your health is, it literally is your lifeline to what you want to do with the money that you have for retirement, and/or what to play with your family, to play with your kids, whatever it may look like. So, definitely making sure your health is a priority within that, even though we tend to not take care of ourselves all the time.
But taking care of yourself, that looks like drinking lots of water. I don’t think people in our society drink enough water, ever. But they say that half your body weight in ounces of water needs to be consumed every single day, so that’s a great place to start to keep yourself hydrated. If you’ve been sitting in a very stagnant position for a long period of time, definitely making sure that you’re stretching. Getting on a good either stretch or yoga routine is fantastic. Meditation is fantastic. It’s a great way to be able to connect just to the present moment.
And then, walking. If you haven’t moved a lot, I always start with walking, start doing some functional movements: squats, small push-ups, if you can do those types of motions. I’m a huge proponent for eating, obviously, really good veggies really good fruits. Good fats, get chiropractic care but limit those processed sugars, limit those processed breads and dairy, all that type of stuff, too. Those are going to be amazing things just for overall health when it comes to keeping yourself healthy, and keeping yourself active because I know for me I want to be 93 and be able to golf. I want to be able to do the things I want to do, but I have to take care of my body to be able to do that.
Zach: Well, Dr. Sara, thank you for those tips. Hopefully, that will come in handy to our listeners out there. So, in closing if you just want to tell us where people can find you, and if they’re interested, and we’d love to point some people in your direction.
Dr. Sara: We are located right by West Town Starbucks, right over by where Classy Lady used to be, and across in Trader Joe’s. That’s where our physical location is. You can find us on Facebook at FreedomKnox. If you just look up Freedom Chiropractic, you’d find us there. We are on Instagram at FreedomKnox as well, if that’s something that people would like to follow us there. Our website is also freedomknox.com. So, an easy way to just go get some more information, and kind of what you’d expect in our office as well, and just give you an opportunity to be able to see if it’s something that would jive with you and your family, for sure.
Zach: Perfect. Well, thank you Dr. Sara for giving us some of your time. I know you’re pretty busy out there, and thanks for being able to jump on and answer some questions for us and help some people out.
Dr. Sara: Absolutely. Thank you guys for doing what you’re doing as well. It’s a pretty amazing asset to be able to have for a resource for people, for sure.
Zach: All right, so for this episode’s product review, we’re going to go over a hospital indemnity plan.
Zach: Nick always gets a little chuckle out of this, I call it a Build-A-Bear plan, just because it is a very flexible plan. It’s got a couple of different base parts of the policy you pick, and then it’s got several riders that you can add on, and—kind of, we’ve talked about before, rider’s just a little something—you know they cost a little more on the premium, but they give you the added coverage for much cheaper costs than if you were to get strictly a policy of just that on its own. So, Nick, starting out, tell them why I call it a Build-A-Bear plan.
Nick: Yeah, absolutely. Great title for the plan. So, hospital indemnity plans are very simply exactly what they say. They are designed, Zach, to cover when a person is in the hospital, to cover expenses that their plan or Medicare does not cover. So, initially the reason we call it a Build-A-Bear plan is this policy has two bases that you can choose from. And I know depending on the client, Zach, we typically choose different ways here, but the client can choose to get a daily indemnity payout, or they can choose a lump sum indemnity payout, meaning each time they’re admitted to the hospital, they get a particular payout. Right?
Zach: Exactly, exactly. So basically, once the client chooses what they want for their base, whether it’s a lump sum or a daily, then we’re going to review the different riders with them. This is where we, Nick or I, will really dig in, ask a lot of questions because we want to make sure we’re building a plan to fit your needs. There’s no need to add a rider that you don’t need, but also, too, we don’t want to have a rider that’s a glaring need there, and we leave it out in the open. So, Nick, there on those riders, you want to run through them real quick and just tell them what’s out there for those options to get the best plan available?
Nick: Absolutely. So, there’s multiple riders available on this policy, and as Zach alluded to, our job is to ask questions, determine the needs—or the lack thereof—that you may have, and that gives us an idea of which one or which ones of these may be the most beneficial. But the ones that this policy offers, Zach, are the outpatient surgery rider. So, if you purchase this rider, you have the ability to get up to $1500 paid to you or your designated beneficiary to cover the costs that your healthcare or Medicare does not.
Zach: Definitely. I think that’s one of the best riders on this plan.
Nick: Yeah, absolutely. Depending on what type of health insurance you have in addition to Medicare, Zach, this certainly can be a very beneficial rider. And then the second one is doctor visits. So, everybody calls this the copay rider. This policy will allow an individual to purchase up to $50 worth of reimbursement each time they go to a doctor visit, whether primary care or specialists.
This policy also offers an emergency room and ambulance services rider that will pay out up to twice per year $200 per payout; an outpatient rehab rider, this rider will allow you to collect an indemnity payout each time you attend rehab and incur costs it pays you; a daily skill facility care rider giving you a daily indemnity to cover the costs that Medicare or your insurance doesn’t pay while you’re admitted to a skilled facility, and last but not least, and most definitely most popular, Zach, is the new cancer and lump sum rider this policy is offering. This rider is becoming very hot, lots of people like it, and basically very simply it allows you to buy $2,500, $5,000, or $10,000 worth of lump-sum cancer coverage for a minimalistic premium.
Zach: Oh yeah, and they added this one on to this plan, that was a game-changer—
Nick: Sure. Absolutely.
Zach: [crosstalk] by that kind of coverage. So, they’re looking at, Nick, so this mentioned, being an indemnity plan, it’s not really a true insurance policy which also allows it not to have any networks.
Nick: Yeah, that’s exactly right. So, when we think of insurance, we think of insurance cards, we think of all these big-name companies that we’re used to. These types of policies aren’t traditional insurance. You’re not showing these cards to your medical facilities. You’re not showing these cards to your doctor’s offices. What’s happening is there’s no networks because technically, the doctors never know these types of coverages exist. When you get your services rendered, they send you an explanation of benefits, and they send you a bill. You submit that to the insurance company for them to disperse your payout, whether directly to you or to a designated beneficiary that you may choose.
Zach: Great, great. Yeah. Like I said, this is a very great plan to custom build it to fit your needs, and it works great with some other Medicare plans that are out there on the market that we’ll touch more on in the coming months.
Nick: Yeah, absolutely. Absolutely. There’s a very common type of Medicare coverage out there that most of its biggest gaps are covered by this policy. So, with it in conjunction with a hospital indemnity plan, they can offer some good benefits, and we’ll be covering that shortly in a following podcast.
Zach: All right, so for this episode’s Medicare confessions, Nick and I both have a couple of stories here I want to share with you guys about this product, just because we have written a lot of these, and they do work so well with Medicare. First off, Nick and I both have several clients that Nick alluded to in the last section. This plan works great with Medicare, and in this situation, these people weren’t in their enrollment period where they could enroll in something, so by purchasing this hospital indemnity plan, they were able to get something to fill in the gaps until they could get a larger more comprehensive plan. And in many cases this paid off for them, they’ve had to go in for an outpatient surgery, they’ve had to go to a doctor visit, they’ve had to go to some type of physical therapy, something like that, and they’ve been able to use this plan to fill in some of the gaps that they’re Medicare doesn’t cover. So, we were able to help them that way, then come their enrollment period, where we’ll look around, but then this hospital indemnity plan renews continuously, so they have both in place so then it keeps working for them.
One client really sticks out to me and this is again for client protection there, we’re just going to call her M, Miss M, just to go through this way. And she wrote her hospital indemnity plan several years ago, and several months back, she had a minor knee surgery. So, when she goes in, right there off the bat, she uses the outpatient surgery indemnity part of the plan. So, then after that—she was a little bit older—they sent her into a skilled care facility for a couple of weeks to work on her rehab, get that range of motion back before they sent her home. So, that was when that daily skilled nursing facility came into play. And then lastly, Miss M goes to regular physical therapy once she’s home, and again, she’s right there, she’s using the outpatient rehabilitation rider. So, this was a plan that’s very affordable, and something just as small as a minor knee surgery paid off large dividends for somebody like that. And these things don’t have to be large and catastrophic, as you can see there. It can be some minor things. It’ll put a little money back in their pocket.
Nick: Absolutely. Minor things add up, too, when it comes to these types of coverages, Zach. So, two cases come to mind here. The first bought this policy and actually had an unintended positive impact. As we alluded earlier in this episode, this policy now has a new rider, the cancer lump sum rider. I had a client that was on a very minimalistic coverage, but didn’t really have the opportunity, or wasn’t in the correct time period to enroll in something more comprehensive.
So, we put this policy in place with all the riders as well, trying to give them a little bit of everything type of coverage. Six months back, I get a call, the client had been diagnosed with cancer, we had assigned a $10,000 benefit rider for this policy. So, she got $10,000 to pay what Medicare would not for her chemo, for her treatment, for anything else that she decided to use the money for. Haven’t spoke with her since, good Lord willing, she’s doing well, but we’re certainly glad that we put that in place. The other client that comes to mind, Zach, is an individual who very similar to your situation, fell, shattered an elbow, and had to have multiple outpatient procedures. This policy not only paid out maximum benefit of 1500 bucks when that happened but more importantly when she was released, she was released in a rehab facility, outpatient rehab, she did almost 12 weeks and was covered throughout based on this policy. So, she certainly gives us great reviews, gives the policy great reviews, and those are just a couple examples of people that have benefited from hospital indemnity coverage.
Zach: We hope you enjoy the second episode of seniors living healthy and we hope that you got some useful information from it. Don’t forget that Part B of Medicare is optional, which means you don’t have to take it in order to receive Part A. The 2020 Part B deductible is $198 yearly, and the monthly premium is going to be on average $144.60. And don’t forget your Part B covers diabetic testing supplies and various durable medical equipment.
If you’re a new listener and enjoyed this episode, go back and give our first episode a listen, where we discuss the ins and outs of your Part A of Medicare. Again, we would like to thank you for listening. We also want to thank Dr. Sara from Freedom Chiropractic here in Knoxville, Tennessee for joining us, again and answering some of our questions, and letting you guys know how chiropractic care and Medicare work together. We hope you guys have a great day and don’t forget to subscribe and be on the lookout for our next episode where we’re going to cover all things Part D of Medicare.
Announcer: Thank you for listening, and we hope you found this episode informative. If we answered your questions, odds are you aren’t the only one wanting to know. So, please share this episode with your friends and family. If you enjoyed this episode, please subscribe and rate our show on Apple Podcasts, or wherever you listen to podcasts to catch all of our episodes. If you want more information, or want to talk directly with Nick and Zach, you can call them at 1-844-437-4253. You can also find them on Facebook at facebook.com/seniorbenefitinc or on their website. seniors-livinghealthy.com. Thanks for listening, and have a great day.