Hello, everyone. My name is Phil Aiello. I am President of Deaf Seniors of America. I am thrilled to welcome everyone to the DSA 2024 Webinar Series. This topic today (October 30, 2024) is Medicare for You and we look forward to learning about the Inflation Reduction Act.
Now, let me introduce our presenter for today, Heather Benjamin. She is with Living Insurance, LLC. She is going to present about the new Medicare changes and how they apply to you for 2025.
For those of you participating using one screen, I want you to be able to see Heather and, then, her slides . If you look in the middle of your screen, you should be able to use your mouse, click and drag either window, the Power Point or Heather, and adjust the size accordingly. I want you to go ahead and do that before we get started with the presentation.
At the end of Heather's presentation, we will have an open Q&A for those of you that have questions. Heather will, if time allows, answer those. Any questions that cannot be addressed today, you can enter into the Q&A tab and we will get those answers to you and we'll post those at a later date.
****DISCLAIMER: The real‑time human stenographic captioning below iis not to be used as a formal record of events nor should it be shared without DSA's permission.
Heather Benjamin: Thank you for that wonderful introduction. First, I wanted to thank DSA. I really appreciated the opportunity to be here today and to share the information with you regarding Medicare and, also, recent changes that will be taking effect in 2025.
As Phil just mentioned, the features of Zoom and how you're able to set up the camera‑‑ so I took screen shots that might help in order to adjust it accordingly.
At the top right‑hand corner, you'll see view. And from that drop‑down option, the two options side‑by‑side speaker and side‑by‑side gallery. It's up to you how you want to ‑‑ which one you prefer.
And, also, the screen here, if you notice the little toggle button here and using that you're able to move and enlarge either side of the screen.
Okay. So let's ‑‑ a little bit about myself and my background. I was born and raised in Washington State, in Seattle. When I was young, I loved games, guessing games and gesturing and using my facial expressions. Later I would see deaf people on TV. I was just fascinated by it. So I went to the library and took out all the collections of media.
Then, in high school, my parents found an evening class at a local college. I took ASL for the first time and that was the first time that I met a deaf person. The deaf teacher gave me my name sign and that I have been using ever since.
Later in college, I studied deaf history, deaf studies, Deaf culture and I moved to California and I went to California State University at Northridge and I studied there as well. Graduated ‑‑ I was a little bit hesitant to join the interpreting field. My boss was deaf and was trying to pull me along and trying to pull me into it. So little by little I acquiesced until I got my confidence up and I was ready and I have been interpreting now for over 25 years.
I moved to Hawaii just for the experience of feeling what it was like to live there, and I lived there for ten years as it happened. I met my husband there in Hawaii. He's deaf. We were married. And my mother, who lives in Washington State, retired and moved to Florida. So my husband and I were ‑‑ had the discussion, we decided to pack up and move to Florida. And we have been living here in Florida, in South Florida, in West Palm Beach, been living here six years.
So, I have been in the interpreting field‑‑ how does that exactly relate to insurance? Well, I noticed that in the interpreting field, from my experience interpreting, that the information was a lack of information access. My sister started looking into Medicare. I was wondering if my studies might be able to help and provide more access to that information. And as soon as I started, a lot of people came up to me and were interested in that information and I realized the amount of need in the community for that information and I have been going with it ever since.
This is a cool picture. And I was 16 in high school. My parents brought me to Gallaudet. Had an ASL summer program and I was able to attend. And it just so happened, a few years ago, my husband and I decided to go to Washington, D.C. just to explore, learn about the history of the area. And I had a friend from Hawaii who went to Gallaudet and said, why don't you come. So we went and visited the campus. And I was trying to figure it out‑‑ and I realized it was exactly 30 years ago that I was at Gallaudet and I had the thing‑‑ I need a picture. I need a picture to have this thing to resemble ‑‑ to remake that photo. So I took it in the exact same place and it was just a wonderful experience. So kind of a cool photo, the difference in 30 years.
Okay. So the focus of why we're here today. Medicare. And that picture is a perfect representation of the complexity of Medicare.
So today I'll discuss four main topics. The basics of Medicare. I'll talk about the Inflation Reduction Act known as the IRA and next steps, and important information to know.
And, so first, many of you already have or may already have the red, white and blue card, the Medicare card, Part A and B for original Medicare.
That was established in 1965. Enacted into law. It includes two parts: Part A and Part B. Part A is for hospitalizations and Part B is for doctor visits, testing, and includes a few other things as well.
So Medicare Part A and B is not all‑encompassing. It is not all ‑‑ it does not include everything. It is meant for basic, basic insurance and what's important.
So, it includes hospitalization, medical, doctor visits. Also the government pays 80%. What is not included? 20%, meaning we are responsible for the 20% of payment. It doesn't include prescription drugs. It doesn't include dental, vision, hearing or long‑term care, as well as other things that are not listed here.
So the point that I wanted to make here is that the original Medicare, Parts A and B, are not enough. There is a lot of financial risks that are involved in that. There is no maximum. Charges could be astronomical. There is no limit and no maximum to the charges that you can incur. So how do you cover those gaps? I'll show you two ways, and you can't do both simultaneously. You have a choice, either one or the other.
So the first that I'll speak about briefly is Medigap, also called Medicare Supplement. And the second opportunity ‑‑ the second option is Medicare Advantage Plans.
So the first one that I mentioned, Medigap, that began in 1966. And remember, the original A and B started in 1965. It was less than a year later they realized that they didn't have enough coverage so they added Medigap.
Then later in 1990, it became more standardized throughout the country. And Congress passed very standardized ‑‑ and Medigap will cover 20%. So the 80% that the government pays, Medigap will pay the other 20%, which is a relief financially. So if you have friends that have mentioned they have Plan N or Plan G or Plan F, those are examples of Medigap plans.
The second option is, also, known as Part C or Medicare Advantage Plans. That was created in 1999.
And I always joke, Part C stands for combo because it includes all in one card. You have A, B, which is the hospital and doctors' visits, medical D, which is prescription drugs. So A, B and D all together in one card; however, there are ‑‑ there are additional benefits including dental, vision, hearing, gym memberships. Sometimes they have over‑the‑counter benefits where they give you money, maybe $50 a month or something, that you can use to buy over‑the‑counter vitamins or prescriptions or, you know, tissues
And just to expand a little bit on Part D for the prescription drugs. That program began in 2006. And the drug ‑‑ the prescription drugs have tiers‑‑ five tiers. The first tier is the most common type of medicine; for example, some people have high blood pressure, cholesterol, acid reflux. Common medications that are typically low cost the first tier typically requires a little bit of money. Then as the tiers go from 1to 5, it increases in amount where 5is the most expensive.
If you have a Medicare Supplement or Medigap, that means that you'll have a separate insurance card for Part D, which will be a separate card. If you have Medicare Advantage, it will be included in the card. So doctors, hospitals, prescriptions, all in one card.
So when you become 65‑‑ you reach the age of 65, there is a time period known as the ‑‑ that you're allowed to enroll; for example, I was born in April, so my initial enrollment period goes back 3months, which would be January, February, March. The month of my birth, April, and then 3months following that, May, June and July. So my enrollment period would be from January1st until July31st, 7months. And that period gives you time to figure out the options, which ones you want to apply for. It is important to know A, B, D. If you don't have and you don't sign up during that enrollment period, there is a penalty.
Remember‑‑ or if I have not mentioned it yet‑‑ B or D. B has a monthly premium. D sometimes, also, has a monthly premium. So if there is a penalty, that will be added on top of the normal premium. And it's not temporary. It lasts forever. So the penalty is forever and can't be removed. So it's really important to know and pay attention to the time frame and make sure that you're enrolling during that period to avoid those penalties.
Okay. So now moving on to that Inflation Reduction Act. So I'll explain what it is, how it affects you, and what the next steps are.
So the Inflation Reduction Act was ‑‑ the law was passed in 2022‑‑ August of 2022. It was signed by President Biden. It had two main purposes why it was created: for the climate, making sure that we had clean energy; and, the second reason, was to meet the needs of vulnerable communities with extra additional challenges, including people who have Medicare. And that was focused primarily on prescription drugs and it actually started in 2023.
And some of you might have diabetes. You might have noticed the difference. 2023, they had a cap of $35 per month for your medical insulin. Before many people who suffered from diabetes, the doctors would tell them and prescribe the insulin, but they were unable to afford it because of the high cost. So it created a conflict of, how do we pay for that when it is a medically necessary prescription? So they had a medical cap, a monthly cap.
Another change, if they have a program known as extra help for people with lower income that are worried about how they're going to pay their prescription drugs and that provides discounts for them. And that program tries to expand more benefits for people. For example, the income level, if my income level ‑‑ the income level is below, then you can qualify.
And, now, if it increases, then more people can join and more people would qualify for that program. And, also, not next year, 2025, but two years in 2026, they'll be able to negotiate the cost of medicines with prescription drug manufacturers. Before, the government was not allowed to participate in negotiations, to that effect, and it was one‑set price. Now the government has given ‑‑ been given the authority to negotiate and get the best possible price. And that will start seeing changes in 2026. And there are ten medications primarily that will be impacted and you'll notice the difference ‑‑ the price difference will decrease as well.
Other changes that are regarding the economy, they don't want ‑‑ they don't want the inflation ‑‑ the inflation to impact the prescription drugs at the same rate as the normal economy. Trying to keep it at a more stable rate.
Okay. So who pays for the medications and how is that calculated? I, myself, if I have Part D and I have my insurance card, I pay for the medication and, also, the insurance pays for the medication. The medical manufacturers pay, so all three of us are responsible for paying. Next year the changes that will be enacted, my responsibility will go down. The insurance will take up the majority of that and the medical manufacturers will increase as well to make up for the amount of decrease for the participants.
Another change for next year is that they'll have a cap for monthly cost. In the past, it used to be high. Now it will be much less. 2,000 for the year. Let me back up just a little bit. In this year, 2024, as in the past, they had phases‑‑ four phases. The first will be the deductible, and I can explain my sign for that.
When I have insurance, I have a part to pay that I'm responsible for. The insurance company then pays in addition to that and we share the cost. So I sign this as a method of cost sharing. Some insurance companies have a deductible, which means, I have to pay my deductible first. Once that is utilized and I paid all of my deductible, then the cost sharing would take effect. So the deductible is the first phase.
So if you have a deductible, you have to get your deductible first and, then, the second phase, which is typically 25% out‑of‑pocket cost, insurance company, medical manufacturers will pay the additional costs. And then it goes into the third phase, which is the same, 25%. And then, finally, the period where I pay a little bit and the manufacturers and insurance companies pay more. Starting next year, this third phase has been eliminated.
So you have the first phase, which is the deductible, the second phase, where I pay 25% and the other parties pay the additional‑‑ up to $2,000 for phasetwo; and, then, after that point, insurance will pay 100%. Then the insurer will not have any responsibility.
So they release that, and it is what is known as a donut hole. I'm not sure if you are familiar with that concept. The concept really is hard to explain in ASL, but they got rid of it and‑‑ completely got rid of it for next year.
Also, other changes for next year. As I mentioned the 2,000 gap, the $2,000 gap, if my medication costs $1,000 a month, does that mean January I go to get my medication and I pay $1,000. February, I pay $1,000. $1,000 out‑of‑pocket? What if I can't? You do have payment options‑‑ can get payment installments set up. You can spread it out over 12months. That is a new option and that will be available next year. What exactly that looks like has yet to be seen. So once we get to the process and it starts, there might be some hiccups. It is a new process. And then as those hiccups are resolved, the process will begin moving more smoothly.
There are three big new changes in that gap, that maximum, the removal of the donut hole, the payment installment plan, and smoothing the cost of prescription drugs throughout the year.
So if you're wondering or contemplating your next steps, first if you already have an agent representative helping you with your insurance, contact them. They can guide you and help you and provide services free of charge. The insurance company pays for that cost.
Around September, insurance companies are required to mail out what's called an Annual Notice of Change. And I put it in the slide so you can see the picture of what it looks like. And you're able to see two columns and they compare the years, 2024 in one column, 2025 in the other. So you're able to see what differences and impacts you will see in the next ‑‑ in the coming year. Those are important so make sure to look out for those.
If you have a Medicare Supplement or Medigap, your Part D will be separate. It will be a separate insurance card. Review the benefits, the medications, make sure that your medications are covered next year.
If you have a Medicare Advantage Plan, make sure to review the benefits and check to make sure that doctors are in network, the medications are covered.
Also, some insurance carriers, because of the new Inflation Reduction Act, the insurance companies will bare more of the responsibility and the insurance companies are trying to get out and leaving this area throughout the United States. We're not sure where. There are some areas that are ‑‑ people that the insurance carriers may stop serving your area.
And they might decide to stay, but they might have different plans. They may have gotten rid of a few plans and only where they used to provide five, they may now be providing three. For example, here in Florida, South Florida, Miami, one insurance company has an HMO, a PPO, and they decided that all PPOs will stop and they'll no longer be offering that for the Miami area. So if a person used the PPO, next year they're not going to have ‑‑ does that mean they're not going to have insurance? They're not going to transfer automatically. So they have to know what to do. They have to know their next steps and they have to transfer through an HMO. If they're not familiar or they don't know, January1st, they'll find themselves without coverage. So it is important to look and check to make sure that you're covered and that all of your ducks are in place for next year.
For Part D, if for some reason you lose Part D and you're unaware, and you realize that you've gone a period of time without that, you may be subject to the penalty. And, again, that penalty, that percentage added to on top of the premium is ‑‑ does not go away.
And just to let you know, typically every year Part B premiums increase at the beginning of every year. For the beginning of 2025, they have not officially announced, but it seems that this year is $174.40. Next year it seems it will be 185. It is about a $10 increase.
If you have Social Security, SSDI, your monthly bill is automatically taken out of that payment. Many people that I work with contact me because they received a letter in the mail and they're not sure what to do with it. They're not sure if it is important. Is it a scam? Is it junk? Should I keep it? Is it okay to discard it? So, please, if you reach out to me, take a screen shot and send to me and I'll be able to advise. I don't mind. I'm happy to help. And all the insurance carriers are free for you. There's no obligation or something that you need to do, no commitments. We're here to help support. The insurance companies pay us and they're responsible for that charge.
So thank you today and I'm open for questions. Looks like one question. A lot of scam calls. For scam calls, I know. I completely relate. They have a do not call list. You can add your name or add your phone number. At that point, they won't call you. But to be honest, I still receive calls.
Recently my mother was victim of a scam. Luckily she caught it. The credit card company noticed it and blocked her card. And she actually swiped to participate in the card ‑‑ in the scam. But luckily, the credit card company was able to deactivate her card in time so she didn't become a victim of the actual scam. But it is very hard. A lot of times they're very believable. You really have to be careful.
And then someone wanted clarification regarding the penalties. So the two, Part A, it's not that common, but I could talk about B and D. So in some cases some people ‑‑ they retire. People retire and then they continue to work so they sign up for Part A and they put B on hold. Later, when they reach the point where they decide to retire, they try to sign up or enroll in Part B and they forget. If you sign up for A and you're still working, that's fine. You can put B on hold. But when you retire, that period begins. So they have a time period. If you go past that initial period, the penalty might be applied.
Also, for Part D, some people get the initial card, the original Medicare card for Part A and B and they don't enroll for Part D; or, they don't enroll in Medicare Advantage Plans, which are typically included in Part D. So maybe a year later or, hopefully, not multiple years, they realize that they were not participating in Part D and, then, they're subject to the penalty. And they'll say, why do I have a penalty added to my premium? And they'll say, no, for a period of time, you didn't have Part D. So that is how it applies. I hope I answered your question.
So Jean asked, which states do I have a license? I am licensed in four different states: Washington State, Hawaii, Florida, and Pennsylvania, and I'm open to getting licensing in other states, if I have enough need and if I'm ‑‑ if I see that there is enough need. But you can text me at any time with questions. I don't mind them. Happy to help.
Someone is asking if their Aetna PPO will be safe? It depends. It depends on your area, where you live, your area, your zip code. If you can provide me the zip code, I can check. And then related to Bonnie's question for interpreting, do insurance companies, are they responsible to provide interpreters? If a deaf representative needs to speak with someone from the ‑‑ regarding their health insurance? I would think so. Insurance companies are responsible, but you might have to fight for that. I might suggest speaking with your doctor's office. Often they will have a billing department and someone there that works in the office so if you go into the office for your doctor's appointment and you already have an interpreter there for the appointment, you might be able to speak with someone at the front desk and say, hey, while I'm there with the interpreter can I speak with someone in the billing department regarding my questions.
Someone asked about the increase for next year. Yes. As I mentioned, the increase will go up to about 185. So about $10. And you're asking about Part B prescription. I can explain the difference between part D prescription drugs and Part B for medical. So Part D prescription drugs would be when the doctor orders the ‑‑ orders the prescription and you go to the ‑‑ you go to get the prescription at this pharmacy, pick that up. That is Part D where you pick it up or it is delivered to your house. Part B is when you go to the doctor's office and they administer it there. For example, if you have a catheter for chemo and you're being treated with chemo, that is not a home‑based treatment. You go to the location and the facility where a doctor administers that medication.
For example, my Mom has vision problems and she required a shot into the eye, directly into the eye. That poor thing. She had to go every month for this shot. Ugh, I can't even imagine. But she went to the doctor and they used the device that held her eye open and kept her eye open and she was not able to blink and they administered the shot directly into her eye.
For that they wouldn't have ‑‑ she wouldn't be responsible. That would be covered under Part B.
Amy is asking about the $540 deductible. If you have tier one medication, you have to pay the deductible. It depends on the insurance. So remember, there are many different insurance providers and each company has different insurance plans. So one provider might have ‑‑ you know, company A might have this many. Company B might have that many, so on and so on for all the providers. There is Humana, Aetna, and the list goes on. So from what I'm noticing so far, tier one, there is no deductible. Typically, the first three tiers, there is no deductible. Once you reach the fourth and fifth tier, they do have a deductible.
I have noticed, too, the first and second tier are no deductible. The third tier‑‑ might have a deductible from the third, fourth and fifth and it depends on the insurance company and plan that you have with them.
James asked about ASL referenced to help senior citizens to help sign up ‑‑ to register for Medicare or enroll for Medicare and Medicaid. I wish. I wish. I have been looking for people that sign or that are deaf that specialize in insurance. I know one deaf person that lives in Texas and they told me but I haven't reached out and contacted them about it. I reached out to the person,our mutual contact, and I said, hey, do you mind reaching out to them so they can reach out to me? But we haven't had success yet in setting that up. Especially for people in different states. If you know of someone, please let me know. Text me. Provide me that information. My phone number for text is available on the slide as well. I don't have a YouTube page, no.
And Kim asked, if you already have Part A, B and C, will I be penalized if in two years I don't have Part D? So C, just to clarify, is Medicare Advantage. Remember, that is the combo. So it has A, B and D typically included. Some people have Medicare Advantage Plans without Part D; however, you have to know that that's because they might have Part D somewhere else. They might have ‑‑ they might have Federal insurance and they have medical insurance already covered and they don't need double. Most people that have Medicare Advantage will have Part D included already.
And, Phil, let me know when to stop. I'm just going to keep going. Just looking through‑‑ yes. So for Ruth, if you have the original here, Parts A and B, then you have the choice. You can either do the Medigap or the Medicare Advantage Plan, either one. But it depends on your state and your age. I'm not sure your specific‑‑ it will depend on your specific information and which one would be best for you.
Joseph, I'm guessing because you have a separate Part D card that you already have the Medigap insurance. So when you go to the doctor, you give them the original Medicare card, A and B and, then, you have an additional card, Part D. You should have another one that they should provide you, the 20%. So I'm not sure why they only gave you two. You should have three. You should have a total of three cards. I don't know why that is, unless Part D is actually Part C, and that way it would include doctors, hospitals and prescriptions all in one, the combo plan.
For Alfred, you have a Kaiser Permanente card in Maryland. The card says you have Part A and B. Typically, Kaiser is a group plan or network, which means they have HMO, PPO options. Those typically include Part D already. So if you notice on the card, the bottom right‑hand corner of the card, it will have MRX, Mary, Romeo X‑ray. So M Mary, R Romeo, X X‑ray‑‑ and it looks like this at the bottom right‑hand corner of the card. And it should have Medicare rx. And that means Part D is included. Do you have‑‑ Sandra, regarding the dental plans. You have a dentist that signs. That's wonderful. Outside your network, I wonder if you have an HMO. HMO is more restrictive. You have to follow the list. If you go to see someone who is not on the list who is not in network, you might have to pay out‑of‑pocket. It is a wonderful idea to ‑‑ to file an appeal and ask. It is a good idea. The insurance companies might allow it. It is a good question.
Barb talks about the State Health Insurance Program or SHIP. Most states ‑‑ I think all‑‑ I'm not sure if it is 100%‑‑ but all states I think ‑‑ I think they have SHIP. A very cool feature about SHIP is they provide guidance surrounding around Medicare and they don't have a bias or ‑‑ well, if you have a good insurance agent, they're not trying to pull you in either direction, but a neutral party who can give you neutral advice and guidance.
>> Phil Aiello: Heather, you have two more minutes.
>> Heather Benjamin: Two more minutes?
>> Phil Aiello: Yes.
>> Heather Benjamin: I see you now. It was small. I couldn't see you. I widened the screen and I was not able to see you previously. Okay.
Bonnie said, the penalty, is it forever? And it really can hurt people. I understand that. It is a disadvantage. So you have ‑‑ that is why I make sure to tell everyone and to make sure that you tell your friends so they're aware.
Sue asked about the Federal. Federal is also complicated. It makes things a little more complicated. I don't want to give you advice here in this forum. Maybe I can speak with you offline, more on a one‑on‑one situation to get more of your demographics and your specifics‑‑ but there are options. You're right. It could be better to stay with BlueCross/BlueShield. So again, I would have to talk more with you and ask more questions to get a better idea of your situation.
So Jeffrey asked if there is a different HMO and PPO. That is a good question to end on. So HMO and PPO‑‑ HMOs have more restrictions but they typically cost less. So if you go to the doctor or you go to the hospital, you pay less; however, there are restrictions. There is a limited amount of doctors, a limited amount of hospitals. And you have to be ‑‑ and you have to go to a provider that is in network. Whereas PPO, they have a group of network providers but you're able to go outside of the network. You're able to go to another state. So if you live here in Florida‑‑ we have a lot of snowbirds here in Florida. If you live here for 6months and live in NewYork for 6months, it is better to have a PPO in that situation because you're not sure if you're going to your cardiologist or if you're going to your ‑‑ if you have a general physician. It is important to have the PPO and have those doctors in this area and have doctors in that area and you wouldn't be limited to the amount of people that are in your ‑‑ in that specific network. However, because of the additional features, PPO is more expensive. So there is a ‑‑ it depends on your situation which one is better. But that is all I have to say.
>> Phil Aiello: Heather, you have provided an excellent presentation today about Medicare and Medicare Advantage Plans. I know I, previous to meeting with you, have received many questions from others, members of DSA, my peers, and now I think we have a better understanding on how to proceed moving forward, especially for our DSA members. This is an excellent resource and the purpose of these webinars. Please do check out our website for additional information. And we will, also, be open to any other presenters that might be able to present valuable information to us. So share those resources for us as well.
Heather, thank you so much. I learned something new today. Seriously.
>> Heather Benjamin: Great.
>> Phil Aiello: This was an excellent use of our time. Thank you again.
Now, one last thing before we close the webinar for today, I just want to recognize two organizations that were responsible for making this webinar happen and that would be Sorenson Communications. We do have a tech specialist working behind the scenes, not just for this webinar today but for our monthly webinars. They actually donate a tech specialist who helps us run these webinars behind the scenes. And, then, I also want to recognize the Lawrence W. Levine Foundation. They are another sponsor and they have other products that they can offer or resources for us for future webinars or information sessions like this one. Thank you again to everyone who registered for this webinar today.
Before we end, I do, also, want to thank the interpreters here today and the captioner for helping to make this accessible to everyone. For those of you that do want captions or a transcript to review after the webinar, please know we will always provide that accommodation, and the purpose is to engage more deaf senior citizens, regardless of your hearing loss.
I do want to announce that our next webinar will be in December, December18th, and we're shifting that to a Thursday. Just like this webinar was originally scheduled earlier, we moved it to today. But our next topic will be the ‑‑ can anyone help me? That next topic is available on our website, and if you are interested, please do register.
On our website, we, also, have upcoming events for 2025. Our conference will be hosted in Kansas City in August of 2025.
So I think, without further ado, I will end this webinar. Thank you everyone again who registered and attended. We appreciate your participation. Have a great day.
****DISCLAIMER: The real‑time human stenographic captioning you are about to view is not to be used as a formal record of events nor should it be shared without the event coordinator's permission.Heather Benjamin: Thank you for that wonderful introduction. First, I wanted to thank DSA. I really appreciated the opportunity to be here today and to share the information with you regarding Medicare and, also, recent changes that will be taking effect in 2025.
As Phil just mentioned, the features of Zoom and how you're able to set up the camera‑‑ so I took screen shots that might help in order to adjust it accordingly.
At the top right‑hand corner, you'll see view. And from that drop‑down option, the two options side‑by‑side speaker and side‑by‑side gallery. It's up to you how you want to ‑‑ which one you prefer.
And, also, the screen here, if you notice the little toggle button here and using that you're able to move and enlarge either side of the screen.
Okay. So let's ‑‑ a little bit about myself and my background. I was born and raised in Washington State, in Seattle. When I was young, I loved games, guessing games and gesturing and using my facial expressions. Later I would see deaf people on TV. I was just fascinated by it. So I went to the library and took out all the collections of media.
Then, in high school, my parents found an evening class at a local college. I took ASL for the first time and that was the first time that I met a deaf person. The deaf teacher gave me my name sign and that I have been using ever since.
Later in college, I studied deaf history, deaf studies, Deaf culture and I moved to California and I went to California State University at Northridge and I studied there as well. Graduated ‑‑ I was a little bit hesitant to join the interpreting field. My boss was deaf and was trying to pull me along and trying to pull me into it. So little by little I acquiesced until I got my confidence up and I was ready and I have been interpreting now for over 25 years.
I moved to Hawaii just for the experience of feeling what it was like to live there, and I lived there for ten years as it happened. I met my husband there in Hawaii. He's deaf. We were married. And my mother, who lives in Washington State, retired and moved to Florida. So my husband and I were ‑‑ had the discussion, we decided to pack up and move to Florida. And we have been living here in Florida, in South Florida, in West Palm Beach, been living here six years.
So, I have been in the interpreting field‑‑ how does that exactly relate to insurance? Well, I noticed that in the interpreting field, from my experience interpreting, that the information was a lack of information access. My sister started looking into Medicare. I was wondering if my studies might be able to help and provide more access to that information. And as soon as I started, a lot of people came up to me and were interested in that information and I realized the amount of need in the community for that information and I have been going with it ever since.
This is a cool picture. And I was 16 in high school. My parents brought me to Gallaudet. Had an ASL summer program and I was able to attend. And it just so happened, a few years ago, my husband and I decided to go to Washington, D.C. just to explore, learn about the history of the area. And I had a friend from Hawaii who went to Gallaudet and said, why don't you come. So we went and visited the campus. And I was trying to figure it out‑‑ and I realized it was exactly 30 years ago that I was at Gallaudet and I had the thing‑‑ I need a picture. I need a picture to have this thing to resemble ‑‑ to remake that photo. So I took it in the exact same place and it was just a wonderful experience. So kind of a cool photo, the difference in 30 years.
Okay. So the focus of why we're here today. Medicare. And that picture is a perfect representation of the complexity of Medicare.
So today I'll discuss four main topics. The basics of Medicare. I'll talk about the Inflation Reduction Act known as the IRA and next steps, and important information to know.
And, so first, many of you already have or may already have the red, white and blue card, the Medicare card, Part A and B for original Medicare.
That was established in 1965. Enacted into law. It includes two parts: Part A and Part B. Part A is for hospitalizations and Part B is for doctor visits, testing, and includes a few other things as well.
So Medicare Part A and B is not all‑encompassing. It is not all ‑‑ it does not include everything. It is meant for basic, basic insurance and what's important.
So, it includes hospitalization, medical, doctor visits. Also the government pays 80%. What is not included? 20%, meaning we are responsible for the 20% of payment. It doesn't include prescription drugs. It doesn't include dental, vision, hearing or long‑term care, as well as other things that are not listed here.
So the point that I wanted to make here is that the original Medicare, Parts A and B, are not enough. There is a lot of financial risks that are involved in that. There is no maximum. Charges could be astronomical. There is no limit and no maximum to the charges that you can incur. So how do you cover those gaps? I'll show you two ways, and you can't do both simultaneously. You have a choice, either one or the other.
So the first that I'll speak about briefly is Medigap, also called Medicare Supplement. And the second opportunity ‑‑ the second option is Medicare Advantage Plans.
So the first one that I mentioned, Medigap, that began in 1966. And remember, the original A and B started in 1965. It was less than a year later they realized that they didn't have enough coverage so they added Medigap.
Then later in 1990, it became more standardized throughout the country. And Congress passed very standardized ‑‑ and Medigap will cover 20%. So the 80% that the government pays, Medigap will pay the other 20%, which is a relief financially. So if you have friends that have mentioned they have Plan N or Plan G or Plan F, those are examples of Medigap plans.
The second option is, also, known as Part C or Medicare Advantage Plans. That was created in 1999.
And I always joke, Part C stands for combo because it includes all in one card. You have A, B, which is the hospital and doctors' visits, medical D, which is prescription drugs. So A, B and D all together in one card; however, there are ‑‑ there are additional benefits including dental, vision, hearing, gym memberships. Sometimes they have over‑the‑counter benefits where they give you money, maybe $50 a month or something, that you can use to buy over‑the‑counter vitamins or prescriptions or, you know, tissues
And just to expand a little bit on Part D for the prescription drugs. That program began in 2006. And the drug ‑‑ the prescription drugs have tiers‑‑ five tiers. The first tier is the most common type of medicine; for example, some people have high blood pressure, cholesterol, acid reflux. Common medications that are typically low cost the first tier typically requires a little bit of money. Then as the tiers go from 1to 5, it increases in amount where 5is the most expensive.
If you have a Medicare Supplement or Medigap, that means that you'll have a separate insurance card for Part D, which will be a separate card. If you have Medicare Advantage, it will be included in the card. So doctors, hospitals, prescriptions, all in one card.
So when you become 65‑‑ you reach the age of 65, there is a time period known as the ‑‑ that you're allowed to enroll; for example, I was born in April, so my initial enrollment period goes back 3months, which would be January, February, March. The month of my birth, April, and then 3months following that, May, June and July. So my enrollment period would be from January1st until July31st, 7months. And that period gives you time to figure out the options, which ones you want to apply for. It is important to know A, B, D. If you don't have and you don't sign up during that enrollment period, there is a penalty.
Remember‑‑ or if I have not mentioned it yet‑‑ B or D. B has a monthly premium. D sometimes, also, has a monthly premium. So if there is a penalty, that will be added on top of the normal premium. And it's not temporary. It lasts forever. So the penalty is forever and can't be removed. So it's really important to know and pay attention to the time frame and make sure that you're enrolling during that period to avoid those penalties.
Okay. So now moving on to that Inflation Reduction Act. So I'll explain what it is, how it affects you, and what the next steps are.
So the Inflation Reduction Act was ‑‑ the law was passed in 2022‑‑ August of 2022. It was signed by President Biden. It had two main purposes why it was created: for the climate, making sure that we had clean energy; and, the second reason, was to meet the needs of vulnerable communities with extra additional challenges, including people who have Medicare. And that was focused primarily on prescription drugs and it actually started in 2023.
And some of you might have diabetes. You might have noticed the difference. 2023, they had a cap of $35 per month for your medical insulin. Before many people who suffered from diabetes, the doctors would tell them and prescribe the insulin, but they were unable to afford it because of the high cost. So it created a conflict of, how do we pay for that when it is a medically necessary prescription? So they had a medical cap, a monthly cap.
Another change, if they have a program known as extra help for people with lower income that are worried about how they're going to pay their prescription drugs and that provides discounts for them. And that program tries to expand more benefits for people. For example, the income level, if my income level ‑‑ the income level is below, then you can qualify.
And, now, if it increases, then more people can join and more people would qualify for that program. And, also, not next year, 2025, but two years in 2026, they'll be able to negotiate the cost of medicines with prescription drug manufacturers. Before, the government was not allowed to participate in negotiations, to that effect, and it was one‑set price. Now the government has given ‑‑ been given the authority to negotiate and get the best possible price. And that will start seeing changes in 2026. And there are ten medications primarily that will be impacted and you'll notice the difference ‑‑ the price difference will decrease as well.
Other changes that are regarding the economy, they don't want ‑‑ they don't want the inflation ‑‑ the inflation to impact the prescription drugs at the same rate as the normal economy. Trying to keep it at a more stable rate.
Okay. So who pays for the medications and how is that calculated? I, myself, if I have Part D and I have my insurance card, I pay for the medication and, also, the insurance pays for the medication. The medical manufacturers pay, so all three of us are responsible for paying. Next year the changes that will be enacted, my responsibility will go down. The insurance will take up the majority of that and the medical manufacturers will increase as well to make up for the amount of decrease for the participants.
Another change for next year is that they'll have a cap for monthly cost. In the past, it used to be high. Now it will be much less. 2,000 for the year. Let me back up just a little bit. In this year, 2024, as in the past, they had phases‑‑ four phases. The first will be the deductible, and I can explain my sign for that.
When I have insurance, I have a part to pay that I'm responsible for. The insurance company then pays in addition to that and we share the cost. So I sign this as a method of cost sharing. Some insurance companies have a deductible, which means, I have to pay my deductible first. Once that is utilized and I paid all of my deductible, then the cost sharing would take effect. So the deductible is the first phase.
So if you have a deductible, you have to get your deductible first and, then, the second phase, which is typically 25% out‑of‑pocket cost, insurance company, medical manufacturers will pay the additional costs. And then it goes into the third phase, which is the same, 25%. And then, finally, the period where I pay a little bit and the manufacturers and insurance companies pay more. Starting next year, this third phase has been eliminated.
So you have the first phase, which is the deductible, the second phase, where I pay 25% and the other parties pay the additional‑‑ up to $2,000 for phasetwo; and, then, after that point, insurance will pay 100%. Then the insurer will not have any responsibility.
So they release that, and it is what is known as a donut hole. I'm not sure if you are familiar with that concept. The concept really is hard to explain in ASL, but they got rid of it and‑‑ completely got rid of it for next year.
Also, other changes for next year. As I mentioned the 2,000 gap, the $2,000 gap, if my medication costs $1,000 a month, does that mean January I go to get my medication and I pay $1,000. February, I pay $1,000. $1,000 out‑of‑pocket? What if I can't? You do have payment options‑‑ can get payment installments set up. You can spread it out over 12months. That is a new option and that will be available next year. What exactly that looks like has yet to be seen. So once we get to the process and it starts, there might be some hiccups. It is a new process. And then as those hiccups are resolved, the process will begin moving more smoothly.
There are three big new changes in that gap, that maximum, the removal of the donut hole, the payment installment plan, and smoothing the cost of prescription drugs throughout the year.
So if you're wondering or contemplating your next steps, first if you already have an agent representative helping you with your insurance, contact them. They can guide you and help you and provide services free of charge. The insurance company pays for that cost.
Around September, insurance companies are required to mail out what's called an Annual Notice of Change. And I put it in the slide so you can see the picture of what it looks like. And you're able to see two columns and they compare the years, 2024 in one column, 2025 in the other. So you're able to see what differences and impacts you will see in the next ‑‑ in the coming year. Those are important so make sure to look out for those.
If you have a Medicare Supplement or Medigap, your Part D will be separate. It will be a separate insurance card. Review the benefits, the medications, make sure that your medications are covered next year.
If you have a Medicare Advantage Plan, make sure to review the benefits and check to make sure that doctors are in network, the medications are covered.
Also, some insurance carriers, because of the new Inflation Reduction Act, the insurance companies will bare more of the responsibility and the insurance companies are trying to get out and leaving this area throughout the United States. We're not sure where. There are some areas that are ‑‑ people that the insurance carriers may stop serving your area.
And they might decide to stay, but they might have different plans. They may have gotten rid of a few plans and only where they used to provide five, they may now be providing three. For example, here in Florida, South Florida, Miami, one insurance company has an HMO, a PPO, and they decided that all PPOs will stop and they'll no longer be offering that for the Miami area. So if a person used the PPO, next year they're not going to have ‑‑ does that mean they're not going to have insurance? They're not going to transfer automatically. So they have to know what to do. They have to know their next steps and they have to transfer through an HMO. If they're not familiar or they don't know, January1st, they'll find themselves without coverage. So it is important to look and check to make sure that you're covered and that all of your ducks are in place for next year.
For Part D, if for some reason you lose Part D and you're unaware, and you realize that you've gone a period of time without that, you may be subject to the penalty. And, again, that penalty, that percentage added to on top of the premium is ‑‑ does not go away.
And just to let you know, typically every year Part B premiums increase at the beginning of every year. For the beginning of 2025, they have not officially announced, but it seems that this year is $174.40. Next year it seems it will be 185. It is about a $10 increase.
If you have Social Security, SSDI, your monthly bill is automatically taken out of that payment. Many people that I work with contact me because they received a letter in the mail and they're not sure what to do with it. They're not sure if it is important. Is it a scam? Is it junk? Should I keep it? Is it okay to discard it? So, please, if you reach out to me, take a screen shot and send to me and I'll be able to advise. I don't mind. I'm happy to help. And all the insurance carriers are free for you. There's no obligation or something that you need to do, no commitments. We're here to help support. The insurance companies pay us and they're responsible for that charge.
So thank you today and I'm open for questions. Looks like one question. A lot of scam calls. For scam calls, I know. I completely relate. They have a do not call list. You can add your name or add your phone number. At that point, they won't call you. But to be honest, I still receive calls.
Recently my mother was victim of a scam. Luckily she caught it. The credit card company noticed it and blocked her card. And she actually swiped to participate in the card ‑‑ in the scam. But luckily, the credit card company was able to deactivate her card in time so she didn't become a victim of the actual scam. But it is very hard. A lot of times they're very believable. You really have to be careful.
And then someone wanted clarification regarding the penalties. So the two, Part A, it's not that common, but I could talk about B and D. So in some cases some people ‑‑ they retire. People retire and then they continue to work so they sign up for Part A and they put B on hold. Later, when they reach the point where they decide to retire, they try to sign up or enroll in Part B and they forget. If you sign up for A and you're still working, that's fine. You can put B on hold. But when you retire, that period begins. So they have a time period. If you go past that initial period, the penalty might be applied.
Also, for Part D, some people get the initial card, the original Medicare card for Part A and B and they don't enroll for Part D; or, they don't enroll in Medicare Advantage Plans, which are typically included in Part D. So maybe a year later or, hopefully, not multiple years, they realize that they were not participating in Part D and, then, they're subject to the penalty. And they'll say, why do I have a penalty added to my premium? And they'll say, no, for a period of time, you didn't have Part D. So that is how it applies. I hope I answered your question.
So Jean asked, which states do I have a license? I am licensed in four different states: Washington State, Hawaii, Florida, and Pennsylvania, and I'm open to getting licensing in other states, if I have enough need and if I'm ‑‑ if I see that there is enough need. But you can text me at any time with questions. I don't mind them. Happy to help.
Someone is asking if their Aetna PPO will be safe? It depends. It depends on your area, where you live, your area, your zip code. If you can provide me the zip code, I can check. And then related to Bonnie's question for interpreting, do insurance companies, are they responsible to provide interpreters? If a deaf representative needs to speak with someone from the ‑‑ regarding their health insurance? I would think so. Insurance companies are responsible, but you might have to fight for that. I might suggest speaking with your doctor's office. Often they will have a billing department and someone there that works in the office so if you go into the office for your doctor's appointment and you already have an interpreter there for the appointment, you might be able to speak with someone at the front desk and say, hey, while I'm there with the interpreter can I speak with someone in the billing department regarding my questions.
Someone asked about the increase for next year. Yes. As I mentioned, the increase will go up to about 185. So about $10. And you're asking about Part B prescription. I can explain the difference between part D prescription drugs and Part B for medical. So Part D prescription drugs would be when the doctor orders the ‑‑ orders the prescription and you go to the ‑‑ you go to get the prescription at this pharmacy, pick that up. That is Part D where you pick it up or it is delivered to your house. Part B is when you go to the doctor's office and they administer it there. For example, if you have a catheter for chemo and you're being treated with chemo, that is not a home‑based treatment. You go to the location and the facility where a doctor administers that medication.
For example, my Mom has vision problems and she required a shot into the eye, directly into the eye. That poor thing. She had to go every month for this shot. Ugh, I can't even imagine. But she went to the doctor and they used the device that held her eye open and kept her eye open and she was not able to blink and they administered the shot directly into her eye.
For that they wouldn't have ‑‑ she wouldn't be responsible. That would be covered under Part B.
Amy is asking about the $540 deductible. If you have tier one medication, you have to pay the deductible. It depends on the insurance. So remember, there are many different insurance providers and each company has different insurance plans. So one provider might have ‑‑ you know, company A might have this many. Company B might have that many, so on and so on for all the providers. There is Humana, Aetna, and the list goes on. So from what I'm noticing so far, tier one, there is no deductible. Typically, the first three tiers, there is no deductible. Once you reach the fourth and fifth tier, they do have a deductible.
I have noticed, too, the first and second tier are no deductible. The third tier‑‑ might have a deductible from the third, fourth and fifth and it depends on the insurance company and plan that you have with them.
James asked about ASL referenced to help senior citizens to help sign up ‑‑ to register for Medicare or enroll for Medicare and Medicaid. I wish. I wish. I have been looking for people that sign or that are deaf that specialize in insurance. I know one deaf person that lives in Texas and they told me but I haven't reached out and contacted them about it. I reached out to the person,our mutual contact, and I said, hey, do you mind reaching out to them so they can reach out to me? But we haven't had success yet in setting that up. Especially for people in different states. If you know of someone, please let me know. Text me. Provide me that information. My phone number for text is available on the slide as well. I don't have a YouTube page, no.
And Kim asked, if you already have Part A, B and C, will I be penalized if in two years I don't have Part D? So C, just to clarify, is Medicare Advantage. Remember, that is the combo. So it has A, B and D typically included. Some people have Medicare Advantage Plans without Part D; however, you have to know that that's because they might have Part D somewhere else. They might have ‑‑ they might have Federal insurance and they have medical insurance already covered and they don't need double. Most people that have Medicare Advantage will have Part D included already.
And, Phil, let me know when to stop. I'm just going to keep going. Just looking through‑‑ yes. So for Ruth, if you have the original here, Parts A and B, then you have the choice. You can either do the Medigap or the Medicare Advantage Plan, either one. But it depends on your state and your age. I'm not sure your specific‑‑ it will depend on your specific information and which one would be best for you.
Joseph, I'm guessing because you have a separate Part D card that you already have the Medigap insurance. So when you go to the doctor, you give them the original Medicare card, A and B and, then, you have an additional card, Part D. You should have another one that they should provide you, the 20%. So I'm not sure why they only gave you two. You should have three. You should have a total of three cards. I don't know why that is, unless Part D is actually Part C, and that way it would include doctors, hospitals and prescriptions all in one, the combo plan.
For Alfred, you have a Kaiser Permanente card in Maryland. The card says you have Part A and B. Typically, Kaiser is a group plan or network, which means they have HMO, PPO options. Those typically include Part D already. So if you notice on the card, the bottom right‑hand corner of the card, it will have MRX, Mary, Romeo X‑ray. So M Mary, R Romeo, X X‑ray‑‑ and it looks like this at the bottom right‑hand corner of the card. And it should have Medicare rx. And that means Part D is included. Do you have‑‑ Sandra, regarding the dental plans. You have a dentist that signs. That's wonderful. Outside your network, I wonder if you have an HMO. HMO is more restrictive. You have to follow the list. If you go to see someone who is not on the list who is not in network, you might have to pay out‑of‑pocket. It is a wonderful idea to ‑‑ to file an appeal and ask. It is a good idea. The insurance companies might allow it. It is a good question.
Barb talks about the State Health Insurance Program or SHIP. Most states ‑‑ I think all‑‑ I'm not sure if it is 100%‑‑ but all states I think ‑‑ I think they have SHIP. A very cool feature about SHIP is they provide guidance surrounding around Medicare and they don't have a bias or ‑‑ well, if you have a good insurance agent, they're not trying to pull you in either direction, but a neutral party who can give you neutral advice and guidance.
>> Phil Aiello: Heather, you have two more minutes.
>> Heather Benjamin: Two more minutes?
>> Phil Aiello: Yes.
>> Heather Benjamin: I see you now. It was small. I couldn't see you. I widened the screen and I was not able to see you previously. Okay.
Bonnie said, the penalty, is it forever? And it really can hurt people. I understand that. It is a disadvantage. So you have ‑‑ that is why I make sure to tell everyone and to make sure that you tell your friends so they're aware.
Sue asked about the Federal. Federal is also complicated. It makes things a little more complicated. I don't want to give you advice here in this forum. Maybe I can speak with you offline, more on a one‑on‑one situation to get more of your demographics and your specifics‑‑ but there are options. You're right. It could be better to stay with BlueCross/BlueShield. So again, I would have to talk more with you and ask more questions to get a better idea of your situation.
So Jeffrey asked if there is a different HMO and PPO. That is a good question to end on. So HMO and PPO‑‑ HMOs have more restrictions but they typically cost less. So if you go to the doctor or you go to the hospital, you pay less; however, there are restrictions. There is a limited amount of doctors, a limited amount of hospitals. And you have to be ‑‑ and you have to go to a provider that is in network. Whereas PPO, they have a group of network providers but you're able to go outside of the network. You're able to go to another state. So if you live here in Florida‑‑ we have a lot of snowbirds here in Florida. If you live here for 6months and live in NewYork for 6months, it is better to have a PPO in that situation because you're not sure if you're going to your cardiologist or if you're going to your ‑‑ if you have a general physician. It is important to have the PPO and have those doctors in this area and have doctors in that area and you wouldn't be limited to the amount of people that are in your ‑‑ in that specific network. However, because of the additional features, PPO is more expensive. So there is a ‑‑ it depends on your situation which one is better. But that is all I have to say.
Phil Aiello: Heather, you have provided an excellent presentation today about Medicare and Medicare Advantage Plans. I know I, previous to meeting with you, have received many questions from others, members of DSA, my peers, and now I think we have a better understanding on how to proceed moving forward, especially for our DSA members. This is an excellent resource and the purpose of these webinars. Please do check out our website for additional information. And we will, also, be open to any other presenters that might be able to present valuable information to us. So share those resources for us as well.
Heather, thank you so much. I learned something new today. Seriously.
Heather Benjamin: Great.
Phil Aiello: This was an excellent use of our time. Thank you again.
Now, one last thing before we close the webinar for today, I just want to recognize two organizations that were responsible for making this webinar happen and that would be Sorenson Communications. We do have a tech specialist working behind the scenes, not just for this webinar today but for our monthly webinars. They actually donate a tech specialist who helps us run these webinars behind the scenes. And, then, I also want to recognize the Lawrence W. Levine Foundation. They are another sponsor and they have other products that they can offer or resources for us for future webinars or information sessions like this one. Thank you again to everyone who registered for this webinar today.
Before we end, I do, also, want to thank the interpreters here today and the captioner for helping to make this accessible to everyone. For those of you that do want captions or a transcript to review after the webinar, please know we will always provide that accommodation, and the purpose is to engage more deaf senior citizens, regardless of your hearing loss.
I do want to announce that our next webinar will be held December18th; our next topic will be on Estate Planning - the flyer and registration link is available on our website, and if you are interested, please do register.
On our website, we, also, have upcoming events for 2025. Our DSA biennial conference will be hosted in Kansas City in August of 2025.
So I think, without further ado, I will end this webinar. Thank you everyone again who registered and attended. We see you. We appreciate your participation. Have a great day.
****DISCLAIMER: The real‑time human stenographic captioning you have viewed is not to be used as a formal record of events nor should it be shared without DSA's permission.
