Courtney Collen (Host): Welcome to Medicare Simplified: a podcast by Sanford Health Plan to help you decide which Medicare options are right for you. I'm your host, Courtney Collen. When choosing a Medicare plan, it's important to remember that Medicare isn't one size fits all. There are many ways to have Medicare coverage and each person should choose the option that best fits needs and lifestyle but it's important to understand the basics while you a shop. To help break down Medicare Advantage and more, I have Jack Arnett, a manager over at Sanford Health Plan to help.
Hi Jack.
Jack Arnett:
Hi Courtney. Thank you for having me today.
Courtney Collen (Host):
Good to see you. Remind us why Medicare coverage is so important.
Jack Arnett:
Well, Courtney, I think more of an official answer would be that, you know, Medicare delivers a guaranteed level of coverage to people who may not be otherwise, you know, be able to afford it. And it helps insulate Medicare beneficiaries from the rising cost of healthcare. And, you know, each person can choose the right Medicare coverage that best fits their needs and lifestyles, but bottom line when people retire and they no longer have access to a group health insurance or retirement plan benefits of that kind, where else would they go? And that's why Medicare was created, you know, back in the 1960s, matter of fact, President Truman, in thirties, actually began us thinking about some sort of socialized national coverage and he actually had a bureau of old-age benefits as part of his cabinet back in the 1930s. Don't think that would quite work today. But that got us thinking and it took over 30 years for Congress to finally come up with what they called Medicare.
Courtney Collen (Host):
Well, thanks to President Truman for that. Can you keep your doctor or specialist?
Jack Arnett:
When it comes to a Medicare, you know, there's two ways of answering that. Can I keep my doctor and specialist? Once you retire and go on to Medicare, the first thing you need to check with your physician is if they accept Medicare patients. Most do, but not all do. Some may choose not to for a variety of reasons, but generally speaking, most providers do accept Medicare as a payment source. But understanding your plan's network helps ensure that you get the care at the lowest cost. A health insurance network is a group of healthcare providers who your plan contracts with to provide services, you know, for a set rate. Getting your services done at an in-network provider provides the lowest cost of cost shares and copays deductibles for you. Going out of network, it’s just the opposite, Courtney, your cost, you know, will rise. Now with some Medicare Advantage Plans, when you choose your primary care doctor, you are also selecting your hospital and your specialty clinics, because generally speaking, you'll find that those are all combined. It's important to remember that Medicare Advantage Plans can add or remove providers in-network at any time. And a doctor may choose to not participate with a Medicare Advantage Plan at any time. There's no, there's no set retirement time requirements, Courtney, that a provider has to be in-network like for a year or two years. It rarely happens, but a provider, a primary care doc, a specialist can choose literally one day to accept the Medicare Advantage Plan and the next day, not. Like I said, it rarely happens, but they do have that option.
Courtney Collen (Host):
So, we've talked about doctor, specialist, primary care provider, but what about my preferred pharmacy?
Jack Arnett:
Sure. Again, your individual plans’ directory, your network directory is your primary source of truth on there. Part D came out in 2006 and a blanket statement would be that most pharmacies participate with most plans, but you want to be sure. You don't want to just take my word for it. I know with Sanford Health Plan, the Align, Powered by Sanford Health Plan, Medicare Advantage Plan, we have over 60,000 pharmacies that participate with us both locally, regionally, and nationally. Lewis, HyVee, Walmart – just to name a few. But most of those providers that have pharmacies included in them, accept most Medicare Advantage Plans but the primary responsibility is going to be on that individual to make sure and check those network directories.
Courtney Collen (Host):
Jack, can I change my coverage or plan after I purchase one?
Jack Arnett:
There's two different sets of rules when it comes to Medicare beneficiaries, Courtney. One, those individuals that have selected a Medicare supplement plan to assist with the deductibles, copays and cost insurance, and co-insurance, when it comes to Medicare. Those individuals can actually choose to switch Medicare supplement companies every month if they want. Now, they have to pass underwriting, meaning there's health questions asked, but there's no restrictions on how many times a Medicare beneficiary can change their Medicare supplement plan. When it comes to Medicare Advantage Plans, there are definite enrollment in disenrollment periods. For most Medicare beneficiaries that choose a Medicare Advantage Plan, after their first initial enrollment time, Medicare has an annual enrollment period and that runs October 15th through December 7th. During that time, Courtney, a Medicare beneficiary can make dozens of changes if they want. The last one they elect takes effect January 1st. Then from January 1st through the end of March, it's Medicare's disenrollment period, for whatever reason, if that beneficiary was not comfortable with the plan, the Medicare Advantage Plan they chose, they can disenroll from that and re-enroll into one other Medicare Advantage Plan. They get one selection during that time or choose to go back to original Medicare. There's a lot of moving parts in that Courtney. So, that's why I always encourage Medicare beneficiaries to get with a trusted advisor. Somebody that is licensed, trained, certified, in Medicare, in Medicare supplements, in Medicare Advantage Plans, just to just to walk them through. You know, there's so many options to choose from and if you are not you know, if you're not prepared, you're going to be just blown away by some of these decisions you have to make once you retire. So, with Sanford Health Plan, we, we partner with 70 over of these licensed trained individuals that can help you with that. I, myself, manage our inside sales team that are also trained, willing, able to assist at any time to walk Medicare beneficiaries, you know, through these options. But the key there is to ask for some help. Most states have SHIP (State Health Insurance Assistance Programs) or SHINE (Serving Health Insurance Needs of Elders) programs that can offer assistance. So, a lot of options for beneficiaries. Some are internet savvy and they like doing some of their own research. My wife and I like to travel, we love doing our own research for our travel and some may choose, you know, to do that on their own. But most, and this is my 25th year in this industry, when I talk to Medicare beneficiaries, they are literally blown away about the amount of options they have and the decisions, you know, they have to make. So, get with that trusted advisor, get with that trusted source and we'd be more than happy to help them with those options.
Courtney Collen (Host):
Well, we appreciate all you do. Thank goodness for you and of those trusted advisors because this is an overwhelming space. And so, we're happy to break it all down with you, especially on this topic, where to start. Jack, thank you.
Jack Arnett:
Thank you, Courtney.
Courtney Collen (Host):
If you'd like to learn more about Medicare Advantage options from Sanford Health Plan, visit Align.SanfordHealthPlan.com or find more information in our episode notes. We'll see you next time.
Align powered by Sanford Health Plan is a PPO with a Medicare contract. Enrollment in Align powered by Sanford Health Plan depends on contract renewal. Sanford Health Plan complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex, or any other classification protected under the law. This information is not a complete list of benefits. Call (888) 605-9277 ( TTY: 711) for more information. If you need language services or information given in a different format please call (888) 278-6485 (TTY: (888) 279-1549). ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 888) 278-6485 (TTY: (888) 279-1549). 注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電888) 278-6485 (TTY: (888) 279-1549). Our customer service lines are available 8 a.m. to 8 p.m. CST, 7 days a week, October 1-March 31 except on Christmas and Thanksgiving, and Monday through Friday all other dates except on federal holidays.
CMS ID Number: H8385_379-308-274 PODCASTArticleDocPharm-PY2022-ND-SD_C, H3186_379-308-274 PODCASTArticleDocPharm-PY2022-MN_C
Last Updated On: 6.01.22 at 10:30 AM
