As the annual Medicare open enrollment period is upon us (October 15th - December 7th), Theresa, our Community Liaison, sat down with Chazsady Davis of Chaz's Insurance & Notary Services, to answer all your burning Medicare questions.
In this episode, Chaz sheds light on key topics that can make a world of difference in your healthcare decisions:
- Medicare Supplements vs. Medicare Advantage Plans
- Guaranteed Eligibility and the rules governing the transition from a Medicare Advantage plan to a Medicare supplement
- Health Maintenance Organizations (HMOs) vs. Preferred Provider Organizations (PPOs)
This is your chance to get expert advice to make the most of the open enrollment period. Don't miss out! Empower yourself with the knowledge you need for your healthcare choices.
#MedicareOpenEnrollment #HealthcareHeroesUnplugged #HomeHelpersBradenton #MedicareExpert
Contact: Chazsady "Chaz" Davis
Owner, Licensed Insurance Broker & Florida Notary Public
Chaz's Insurance & Notary Services
[Theresa] I am so glad that you are the expert in this. I have quite a few years to go still, but gosh, I hope you’re still around in your local. She’s my new best friend. She’s my new best friend.
Hello, everyone, and welcome to HealthCare Heroes Unplugged with Theresa Capuano-Scott from Home Helpers of Bradenton. Today, I have a very special guest. With me was Chazsady Davis from Chaz’s Insurance & Notary Services. Hello. Welcome, Chaz.
[Chazsady] Thank you.
[Theresa] Thank you so much for being with us today. Chaz is gonna answer some very important questions for us today about Medicare. This is Medicare open enrollment season. So we thought that this would be the best time to chat with Chaz so that we could learn more about Medicare. Thank you so much. So, Chaz, how long have you been performing the insurance services and your notary services?
[Chazsady] So, I’ve had my insurance agency for a little over a year now, but I come from working in skilled nursing facilities and home health care. So, I know how to explain Medicare benefits to beneficiaries, how it works, and how to educate people on their Medicare benefits.
[Theresa] You have a lot of experience working with a senior population and lots of different questions that may come up regarding all different kinds of resources and services that are available to them.
[Chazsady] Yes. Correct.
[Theresa] So, I’m going to ask you the first question that comes to my mind when I think about Medicare. Can you tell me what the difference is between a supplement and an advantage plan?
[Chazsady] Yes. So, with an advantage plan, they are considered value-based care plans. With a supplement plan, it is more of a fee-for-service plan. So, with your advantage plan, I always explain to people it’s like you’re shopping at Walmart, your one-stop shop, so you have your A, B, C, and D all under one plan. You carry one insurance card around, but you have to pretty much play by their rules, right? So, you have a network of doctors that you are required to stay with, depending on your plan. But you should really stay in the network with those doctors that are contracted with that Advantage plan insurance company.
Now, with a supplement plan, they are also with insurance companies, but you have free insurance cards. So, you have your red, white, and blue card, which is your primary insurance. And then, you have your supplement card, which covers the 20% of your part B charges. If you have regular Medicare, then you have your prescription drug card. So, you have three insurance cards and three different insurance companies that you’re dealing with.
So, as far as the differences, one with your advantage plans, there is a network that you have to follow or stay in and with. You pay your co-pays and your co-insurance every time you use it, and you have an out-of-pocket Max. So, it’s similar to traditional health insurance in that aspect. With your supplement plans, you pay a monthly premium, and then when you go and use it. So, when you go to your doctors, and you go and get your lab work done, there are no co-pays because they’re paying that 20% that you’re responsible for.
Another difference is with supplement plans, for the most part, they do not cover dental, vision, hearing, transportation, over-the-counter cards, or any of those extra bells and whistles that come with the Advantage plans. So then, you may also have to get dental and vision coverage outside of your Medicare plan because those are not covered under Part B. So, pretty much with a supplement plan, you pay your monthly premium, you do not pay whenever you go to the doctor with your advantage plan, there’s no monthly premium, but you pay every time you use it. So, that’s pretty much the main difference between the two.
[Theresa] So, I’ll say this, thank God for you because my head is spinning. How about you guys? It sounds like there’s so much that goes into it. It’s going to be specific to each person. You really need a professional like Chaz to sit down with you, go over all of your options and all of the health concerns that you have, and probably go over finances and see what is best with your budget and for your care needs. So, thank God we have someone like Chaz in our corner. Can you tell me another question I had? So, if I have Medicare Advantage and I want to drop that and go back to the Medicare supplement plan, are you able to do that?
[Chazsady] Yes, some individuals are, and some individuals aren’t. So, if you want to learn more and read exactly what I’m about to talk about, it’s called guaranteed eligibility. So, if you go to medicare.gov, you can look up guaranteed eligibility, and that’ll explain this. But pretty much, in a nutshell, there are three times in your life that you can enroll in a supplement plan without any health underwriting questions.
The reason why these companies offer or ask you health underwriting questions outside of those three circumstances is because they know that the 20% that they’re responsible for is going to be a lot more as you get older, as you start seeing more specialists needing more services. So, they’re like, well, we need to put a limit on when people can enroll in these plans and get these plans.
So, the first one is whenever you first turn 65, so three months before, three months after your date of birth of turning 65, you can enroll in a supplement plan with no underwriting questions. So, guaranteed issue to guarantee to get it. The second circumstance is, let’s say, you have employer coverage after 65. You’re not retiring, you’re still employed. They have the benefits. You keep that coverage if you decide or when you decide to retire. If you lose that coverage. Once you leave your job, you have a certain time frame to enroll in a supplement plan without any underwriting questions. So, that’s the second time.
The third time is, let’s say you turn 65 and you get on a supplement plan, and let’s say the next year you want to try an advantage plan out. You have one year to try that advantage plan out before you can go back to your original supplement plan with the original company that you had. Any time outside of those three periods of life, you have to go through the health underwriting questions to get that supplement plan. Those questions are normally about 15 questions depending on the carrier, but they are related to the diagnosis that seniors get.
So, COPD, CHF, diabetes, you know, it’s your main scene, your health conditions that a lot of people have. So, any time you answer yes to one of those questions on the application, it’s an automatic denial. So, when you’re turning 65, you really need to take into consideration getting that supplement plan because that might be the only time you can get it. But if you’re working with an agent that knows these things, they can explain that to you, and then you would make a decision based on that.
[Theresa] So, it sounds like as we age and different health concerns come up, you really need to sit close to your insurance agent. Yes. Because there are just things that can change on a dime, and you really need that great guidance.
[Theresa] So, I’m glad you’re here for our community. Yes. And by the way, Chaz provides services to Sarasota and Manatee County.
The last question that I have for you is to explain the difference between an HMO and a PPO.
[Chazsady] Yes. So, an HMO is a health maintenance organization. So, what they are is it’s an insurance company. So, with your advantage plans, this is what it’s focused on. Advantage plans with your HMO, they have certain networks. You have to stay in that network of doctors. The only way that you will be covered out of network is if it’s a hospital emergency.
So, as a senior and you’re getting older, you’re seeing a lot more doctors. You have a lot of specialists and services that you need. It might be more beneficial to go on a PPO plan. So, a PPO plan has both in-network and out-of-network benefits. So, for the most part, you want to stay in-network because it’s cheaper. But if for some reason you had to see a specific specialist, if you had a PPO plan, it wouldn’t be a problem for you to see that specialist.
Now, if you have an HMO plan and that specialist is not in their network, you cannot see that doctor as long as you want your insurance to cover it. So, I always tell people that if they don’t qualify for a supplement plan and they’re on an HMO plan, and they need to start seeing more doctors and having more specialists and things like that, a PPO plan might be more beneficial to get all of those services covered.
[Theresa] Wow, that’s a mouthful. Yes. I am so glad that you are the expert on this. I have quite a few years to go still, but gosh, I hope you’re still around in your local. And this, she’s my new best friend.
Well, Chaz, I want to thank you so much for explaining all of these different options that are available to our listeners. We will provide Chaz’s contact information and business information right down at the bottom here. Please reach out. She is available to answer any questions and can perform a free consultation.
[Chazsady] Yes, free consultation.
[Theresa] Well, again, this is Chazsady Davis with Chaz’s Insurance & Notary Services. We thank you so much for watching today.
[Chazsady] Thank you.
HOME HELPERS OF BRADENTON
Home Helpers of Bradenton is one of the region's leading home care franchises specializing in comprehensive services for seniors. Home Helpers' sole mission is to make life easier for clients and their families. Based in Bradenton, Florida, the company serves all of Manatee County, including the communities of Anna Maria, Bradenton, Bradenton Beach, Ellenton, Holmes Beach, Lakewood Ranch, Longboat Key, Palmetto, and Parrish. For more information or to request a free in-home care assessment, contact our office at (941) 499-5946 or visit our website at www.homehelpershomecare.com/bradenton