Navigating Medicare’s Annual Enrollment Period with Christian Worstell

Join Kosta and his guest: Christian Worstell, Senior Medicare and Health Insurance Eductor with HelpAdvisor.com. As a licensed health insurance agent and industry advocate, Christian has helped thousands of Americans better understand their health insurance and Medicare coverage.

Featured everywhere from Forbes, MarketWatch, WebMD, and Yahoo! Finance, Christian’s primary goal is to provide accessible information on healthcare coverage, limiting out-of-pocket Medicare spending, and how to access quality medical care.

Find out more about Christian Worstell and HelpAdvisor.com
https://www.helpadvisor.com/authors/christian-worstell
https://www.helpadvisor.com/

Find out more about Kosta Yepifantsev:
https://kostayepifantsev.com/

Transcript

Christian Worstell: 0:04

If you're on Medicare, obviously you're getting older every year. The key is really making sure that your plan aligns with your needs. And I think it's important to kind of every fall do kind of an audit of your health and see where you're at and examine your plan and see if that plan still aligns with those needs.

Caroline Moore: 0:27

Welcome to Now or Never Long-Term Care Strategy with Kosta Yepifantsev a podcast for all those seeking answers and solutions in the long term care space. This podcast is designed to create resources, start conversations and bring awareness to the industry that will inevitably impact all Americans. Here's your host Kosta Yepifantsev.

Kosta Yepifantsev: 0:50

Hey, y'all, it's Kosta. Today, I'm here with my guest Christian Worstell Senior Medicare and health insurance educator with health advisor.com. As a licensed health insurance agent and industry advocate. Christian has helped 1000s of Americans better understand their health insurance and Medicare coverage featured everywhere from Forbes MarketWatch WebMD, and Yahoo Finance Christian primary goal is to provide accessible information on health care coverage, limiting out of pocket Medicare spending, and how to access quality medical care, Christian to start the episode, will you explain to us what the Medicare Annual Enrollment period is, and why it's so important for beneficiaries to be aware of it?

Christian Worstell: 1:36

Yeah, first of all, thanks for having me on. Good to talk to you about this today. AEP Medicare annual enrollment period. For most people, it's the only time of year that you can make changes to your private Medicare coverage. So we're talking medicare advantage and medicare part d. When you first become eligible for Medicare, you will be able to enroll in private Medicare, you'll have a seven month it's called an initial enrollment period or IEP. If you don't sign up, then you will have to wait to until the annual enrollment period in the fall. Or if you are in a plan that you're maybe not fully satisfied with. And you want to explore other options other plans. AEP is your chance to switch from one plan to a different one. And the reason it's important is because, again, for most people, this is their only opportunity during the year to do this. So once you're committed to a plan, you're probably not going to be able to switch to a new one until the following AEP the following year. So you might be stuck with a plan that you don't really love for a year. It's also important, if you know you might run into a coverage gap. A lot of Medicare Advantage plans will include things like routine dental coverage. Well, if you don't get into a plan that has routine dental coverage, then you need to figure out what you're going to do about your dental coverage for the next year. Are you going to pay for it? How are you going to buy a standalone dental plan you'll need to kind of patch things up there. So it's really just you know, making sure that you're setting yourself up for success for the next year until the next AV.

Kosta Yepifantsev: 3:38

Let me let me dig a little deeper. Give me some background about the difference between IEP and AEP and you touched on it a little bit, but I just want to just to put it in layman's terms, what's the difference between the initial and the annual

Christian Worstell: 3:56

Yep, initial, you turn 65. And you're gonna begin a seven month enrollment period, you have seven months to enroll in coverage, Medicare Advantage Medicare Part D Original Medicare, and then annual enrollment period. It happens every year, October 15 to December 7, so just a little less than two months, and those dates don't change. So no matter what day of the week, you know, it might start on a Saturday, it might start on Wednesday, October 15. It starts December 7, it ends so you only ever ever get one initial enrollment period. But you'll get an annual enrollment period every year. So you might get 25 Annual Enrollment Periods but you only get that one initial

Kosta Yepifantsev: 4:47

period. What what happens if you turn 65 And you just don't enroll into into Medicare. What happens if you miss the deadline for the initial enrollment period? But I also want to know what happens if you miss the deadline for the annual enrollment period that October to December period. Yeah, so

Christian Worstell: 5:10

most parts of Medicare do have Late Enrollment penalties. So if you do not sign up when you're eligible, and that initial enrollment period closes, at some point down the road, when you do get it together and sign up, you will probably pay higher premiums. There are some exceptions, but most people are going to be subjected to those late enrollment periods or penalties. And the penalties are not necessarily just a one time thing, it's actually an increase in your premium it might be, you know, 3% added to your premium for every 12 month period that you didn't enroll or something like that. So you're going to be paying for that late enrollment, every month, when you make that premium payment. That's really the biggest risk. The other risk, obviously, is just going without health insurance or going without adequate health insurance during that time until you change and sign up.

Kosta Yepifantsev: 6:15

And so with regards to the Annual Enrollment period, the consequences of missing that deadline is obviously if you already have Medicare, like traditional Medicare, or even Medicare Advantage, for that matter, you just won't be able to make any changes to plan if that's necessary. Right?

Christian Worstell: 6:33

Correct. Yeah, there are certain there's what's called a special enrollment period. And not to try to get too far into the weeds here. But there are people that might qualify for a special enrollment period throughout the year based on certain circumstances that happen. But you're right, for most people, its annual enrollment period, or bust, and your that's your, you know, seven week period eight week period that you get to do every fall. And if you don't do it, then you're having to wait until the next one. So that's why we really stressed the importance of you got to take action now. Because it's now now until next year, I should say,

Kosta Yepifantsev: 7:14

yeah, it's now or never, it's a good point. So, I do want to say, I want one more follow up question. And then we're going to talk about Medicare specifics about how it's changing. And obviously, you know, kind of what's new and coming down the pike. Why is there a penalty? What is what is it about not taking Medicare, that the federal government or or whatever entity Centers for Medicare and Medicaid said they want everybody to enroll in Medicare? I was curious if you knew why there's an actual penalty for not taking Medicare after 65. I think it

Christian Worstell: 7:51

probably boils down to keeping costs lower for everyone across the board, because it wasn't a late enrollment penalty. If you turn 65, and you say, Hey, I'm healthy, I'm still pretty spry, I could probably put it off for a couple of years, well, then you're not paying into the system. Right? And then you get into that situation where you know, only the sick people are enrolled in Medicare and the costs are higher. So I think it's kind of maybe a similar strategy to, you know, the ACA and mandaps. Having penalties for that. It's just an effort to get everyone contributing to keep costs lower across the board.

Kosta Yepifantsev: 8:33

Absolutely. All right. So let's get into it. How is Medicare changing? And what's new for 2024? Yeah, so

Christian Worstell: 8:42

every year, there are some changes to Medicare. Some years, those changes are bigger than others. Okay, over the last few years, due largely because of COVID. There were a lot of changes, you know, they introduced some more telehealth coverage and things like that. I expect 2024 to be relatively quiet when it comes to changes or things that are new. As AEP inches closer, we may learn about some of the more new or changed Medicare Advantage benefits. A lot of times it's right up until AEP when we actually find out about the some of these changes once they're finalized and formally announced. But one thing you can expect premiums and deductibles for both traditional or Original Medicare and private Medicare typically change every year. There has not been a formal announcement yet but it should be coming probably any day now. Usually by the end of September. About the Medicare Part B premiums. The projections are showing it to go up about $10 a month, and those projections are usually pretty ballpark accurate. So we can expect that it actually went down last year, which is why the models are showing probably tick up this year. Yeah. Part Willie? Oh, I'm sorry. Good.

Kosta Yepifantsev: 10:21

I was just gonna say, will there be any I know, a few years back, they added a kind of like a homemaker, non medical type of component to some Medicare Advantage plans. Has there been any news or appetite, I guess, for traditional Medicare to take on that same kind of benefit?

Christian Worstell: 10:41

I think there is an appetite. It's not something that we're going to see in 2004. But it wouldn't shock me if that was kind of the next thing coming. You know, sometimes, things often get introduced to private Medicare, first Medicare Advantage, and then they might get adopted by Original Medicare. One example of that is acupuncture. A few years ago, acupuncture became approved for Medicare Advantage plans, what you know, under certain circumstances, for lower back pain, stuff like Cher, and it was offered exclusively in Medicare Advantage for a couple of years. And then Original Medicare said, Hey, this is good. We want to adopt this. So now you can actually get it with Medicare Part B. The, you know, the aging in place or homemaker, you know, those kinds of services that you speak of, a lot of them are available today and Medicare Advantage plans and have been for a few years. It wouldn't shock me if that one day was adopted by Original Medicare. But yeah, no news on that, as of

Kosta Yepifantsev: 11:52

are you excited about the negotiations for drug pricing? I know it's not going to happen, you know, it's not going to go into effect for a number of years. But how is that going to change Part D?

Christian Worstell: 12:04

Yeah, and in fact, that's kind of a good jumping off point, because a lot of the changes for 2024 are actually happening in part d. So for one, the models are showing that the average monthly premium will probably tick down just slightly. There's also the long story short part D benefits are going to actually improve in 2024. So some of the coinsurance payments that you have to make for drugs are going to disappear during certain coverage phases. The out of pocket spending limit for brand name, drugs looks like it's going to be lowered. There's a coverage gap that looks like it's going to be eliminated. And it also looks like it's going to be easier for people to qualify for cost assistance. So yeah, I think the the ability to negotiate drug prices is a real game changer, because that puts, you know, it kind of shifts the balance of power from you know, the drug manufacturers to, you know, consumers a little bit.

Kosta Yepifantsev: 13:15

I mean, it would be great if they could get a actual drug that works for Alzheimer's would you want to talk about and I'm sure Medicare would be more than happy to, to not negotiate for that pricing, because that is something that is obviously affecting a lot of us so

Christian Worstell: 13:31

so that's interesting. You say that because the big reason why the Part B premium is projected to go up a little bit in 2024 Is that part B is now going to offer coverage of an Alzheimer's drug that has performed very well in clinical trials. Wow, that do not have the name of it in front of me.

Kosta Yepifantsev: 13:55

It's is it add a hell? I think that is it. I think I've been hearing it over Yeah. And and so I'm excited to see that

Christian Worstell: 14:03

it's performed well, they're they're obviously optimistic enough about it to go ahead and begin covered covering it. And as you know, you know, he's Alzheimer's drugs are so expensive that if Original Medicare is going to cover it, they're gonna have to raise the premiums, because it's, we're not at that place yet where those types of drugs are just easily affordable. So yeah.

Kosta Yepifantsev: 14:27

And one thing I wanted to ask you as a segue, you know, there is Medicare Advantage plans are becoming more and more part of popular, so like private Medicare plans, essentially. And I think it's something along the lines of like 30% or 40% of Medicare enrollees select Medicare Advantage. It's actually not 50%. Now it's 50%. Okay, great. So like, obviously there's a shift to where instead of it being the red, white and blue card, traditional Medicare, it's, you know, Cigna or or Aetna or you know WellCare, whatever it might be wellspring. But I want to ask specifically about the beneficiaries. What steps should Medicare beneficiaries take to assess whether their current plan still meets their needs?

Christian Worstell: 15:18

Yeah, there's a few things. I think the first one is, have your healthcare needs changed, because in 2023, your healthcare needs were, you know, x, right. But in 2024, they might be different. I mean, we're, you know, if you're on Medicare, obviously, you're getting older every year, your health care needs might change, you might develop different, you know, conditions. And the key is really making sure that your plan aligns with your needs. And I think it's important to kind of every fall, do kind of an audit of your health and see where you're at and examine your plan and see if that plan still aligns with those needs. I think another thing is, is your doctor, still part of your plan network, because doctors can leave a plan network every year. So your favorite doctor that you've been seeing for 20 years, you have a great relationship with them great rapport. They've accepted your plan for all these years, and all of a sudden next year. They're no longer accepting your insurance they've was, you know, Aetna or whatever.

Kosta Yepifantsev: 16:34

Yeah. But like Does that happen with traditional Medicare, or is that only like a dynamic that's specific to the private Medicare sector

Christian Worstell: 16:43

is certainly more specific to the private sector. Something that you like 95% Plus, of all healthcare providers accept Original Medicare. However, the percentage of them that are accepting new Medicare patients is a little bit lower, probably closer like 85%. Interesting. So your doctor might accept Medicare, but they may not accept new Medicare patients at this time. So it does play into that a little bit.

Kosta Yepifantsev: 17:17

But we could have a conversation about that. Absolutely, yeah. Christian, what do you think is the most common mistake people make when it comes to Medicare?

Christian Worstell: 17:29

Yeah, I mean, we talked about waiting too long to sign up missing that initial enrollment period or missing, you know, the annual enrollment period, facing late enrollment, penalties facing coverage gaps, stuff like that. We talked about, you know, signing up for a plan that includes your favorite Doctor, I see people that sign up for Part D plans that don't cover their drugs that they need. Or people that signing up for plans that may not cover their specific health care needs. You know, if you wear glasses, you probably want a health insurance plan that gives you you know, annual exams and allowance for, you know, Vision Insurance, essentially.

Kosta Yepifantsev: 18:16

Yeah,

Christian Worstell: 18:17

you know, you know, make sure that it lines up. I think just not not taking the time to shop around and compare plans, you know, most people have, it's not uncommon for people to have their choice of like 20, different Medicare Advantage plans that are sold in their area. I mean, you have all most people have a lot of options at their disposal, take the time to sit down and compare them. Invest 30 minutes of your day, to set yourself up for the next year of having good, affordable coverage. And then the last thing I would say is people that try to navigate the process alone, rather than working with an agent, because an agent can just gather up all the plans that are available in your area, help you comb through them help you compare them. If you're trying to go about it alone, you're trying to pull in all of those individual pieces yourself and visit all of the different carrier websites, and it gets gets pretty calculated.

Kosta Yepifantsev: 19:18

Where do they find their local Medicare specialized agent?

Christian Worstell: 19:24

Yeah, so I mean, Medicare advantage.com Okay. It's one of the largest sellers of Medicare Advantage and Medicare Part D coverage. I believe it's available in all 50 states. There are something like 1500 agents. They specialize in Medicare You know, so a lot of other agents are selling regular health insurance or they're selling life insurance but Medicare advantage.com They only sell private Medicare insurance. That's what they do. All day every day.

Kosta Yepifantsev: 19:59

Yeah. I'm, and I've heard I've heard so many stories of people, and I'm so glad that we're talking about this, of say, for example, you know, you're watching TV and a commercial pops by and it's called this number, you know, and it looks like a red, white and blue Medicare card and they call the number, and the person on the phone essentially, you know, has gets them to switch to their Medicare Advantage plan with whatever insurance company, they get paid a premium or a fee. And the insurance that they get, does not meet the needs and expectations of the individual. And they have to wait until the next, you know, enrollment period to switch back to, to what have you. And so I think I'm very glad that we are putting together a process in a pipeline for people to actually reach out to the, to the correct individuals who have their their best interests in mind. So Exactly, yeah, let's let's talk about the process of switching from one plan to another plan. Is it a complicated process,

Christian Worstell: 21:06

it's really not, and especially if you work with an agent. So if you get on the phone with a licensed insurance agent, especially one that just specializes in Medicare, they can actually disenroll you from your old plan, get you enrolled in your new plan, during the same phone call, you do not have to have any contact with your previous carrier, they will handle all of that behind the scenes. So no, it is not complicated. Really the most complicated process is just the shopping and comparing part and choosing from your many options. And once you zero in on the plan that's best for you. It's actually really simple. It's it's pretty quick and painless, to be honest. So no, not complicated at all.

Kosta Yepifantsev: 21:59

In your opinion, aside from the ones that we've already mentioned, what are the most important factor beneficiaries should consider when choosing a new Medicare plan?

Christian Worstell: 22:10

Yeah, I think the whole HMO versus PPO plan is pretty important. I think, you know, Medicare is not radically different from you know, employer based coverage, or most people that are transitioning to Medicare, they've probably been on health insurance for 30 or 40 years. And a lot of those routes are still there, like HMO or PPO. So do you want an HMO plan? That's a little bit more of a team oriented approach where you know, your team of doctors are referring you within the network? Or do you like the PPO approach where you have maybe a little bit more personal freedom over your your healthcare choices, and you can go outside of a network? I think that's important for people and and by the time they get to Medicare, they've probably figured out if they're an HMO person or a PPO person. I also think, you know, I asked people, How do you like to spend? Do you want to pay higher monthly premiums up front, in exchange for lower deductibles and lower CO payments when you use the insurance? Or do you want to pay lower premiums upfront and then reach a little bit deeper into your pocket when you use the insurance for higher deductibles and, and higher CO payments or coinsurance? There's no really right or wrong universal answer there. Everybody likes to spend their money differently. And I think he just has to have to ask yourself, you know, how do I want to spend my money? I think that's, that's a really important thing that I think gets overlooked a little bit too much by people.

Kosta Yepifantsev: 23:46

We always like to end the show with a call to action. For anyone who wants help with this process. What's your advice on finding a knowledgeable and licensed insurance agent who specializes in Medicare?

Christian Worstell: 24:02

Yeah, so I mentioned it previously, but Medicare advantage.com is the one that I always recommend to people first. Like I said, they're one of the largest sellers, they specialize in it, you know, over 1000 agents, they're all US based agents. They even have bilingual agents for those that need it. And it really is the best way they're all licensed, you know, highly trained, experienced, but you know, they can disenroll you from your previous plan and enroll you in a new one. They can also just sit there and answer your questions. And you know, there's a lot of things that you may not understand about Medicare. They'll sit there and help you, you know, they'll talk you through you know, how this works, what these benefits mean, you know, you know, come through all of those, you know, terms and conditions and fine print. So they're kind of part advisor part agent. They can help sell Will you a plan and get you enrolled but they can also just help you understand it better and kind of advise you on you know this plan versus that plan etc so let's Medicare advantage.com Is the always kind of the place to

Caroline Moore: 25:14

Thank you for joining us on this episode of Now or Never Long-Term Care Strategy with Kosta Yepifantsev.If you enjoyed listening and you wanna hear more make sure you subscribe on Apple podcast Spotify or wherever you find your Podcasts,leave us a review or better yet share this episode with a friend. Today’s episode was written and produced by Morgan Franklin. Want to find out more about Kosta? Visit us at kostayepifantsev.com