The Retirement Success in Maine Podcast Ep 065: The Ins and Outs of Medicare

 

 

Transcript:

Ben Smith:

Welcome everyone to The Retirement Success and Maine podcast. My name is Ben Smith, and allow me to introduce the Mandalorian to my Grogu, Curtis Worcester. How you doing today, Curtis?

Curtis Worcester:

I'm doing great, Ben. How are you?

Ben Smith:

I'm great. I'm great. I just came back from Disney. So we did the whole Hollywood studios.

Curtis Worcester:

You got to throw it.

Ben Smith:

Of course, everything's Mandalorian Grogu.

Curtis Worcester:

That's right.

Ben Smith:

So we are on episode 65, right?

Curtis Worcester:

That's right. We are.

Ben Smith:

This is the number. So what's one thing that every person in the United States then becomes eligible for when they reach age 65?

Curtis Worcester:

That's a big one.

Ben Smith:

That's Medicare, right?

Curtis Worcester:

That's right.

Ben Smith:

So we thought, well, again, we had to wait 64 episodes before we have a conversation about Medicare. So we've been very patient, but our show now is, if it was a person, it would be Medicare eligible at this point.

Curtis Worcester:

That's right.

Ben Smith:

So we've talked to Elizabeth Newport about Social Security. We had a lot of feedback from our clients, our listeners, and our friends just there's so much they didn't know about the ins and outs of Social Security that we said, "We also have to do that same thing for Medicare," right? We really wanted to talk about how do we access Medicare, what are the steps to applying, what are the influences of paying more or less for the benefit-

Curtis Worcester:

That's right.

Ben Smith:

... how do we access Medicares we age, and how do I find the right mixture of Medicare coverages for me. Then also, we wanted to get into what mistakes do people make when they're on Medicare. So that was really the premise of today's show. Again, we're 65. So it's time to have these conversations.

Curtis Worcester:

We made it. We made it. So as we always like to do, we reach out and find an expert in the field. So obviously today, we have someone that helps educate the public on how to maximize their Medicare benefits. So today's guest is the Community Services Manager at Eastern Area Agency on Aging or as you'll hear me say, we're going to call that E triple A so that I don't butcher that name there.

Curtis Worcester:

So she has worked at E triple A since 2018. Before joining E triple A, she spent 13 years working within the mental health field. She has a passion for working with adults providing education and assistance to find ways to improve the quality of their life. She strongly believes in E triple A's mission and work they do within the four counties that they serve within the state of Maine.

Curtis Worcester:

When she's not working, she's enjoying her other passion in life, which is being a mother of two. They keep her busy, and she can confidently say that her life is never boring. So with that, I would love to welcome Jami Aleksiev to The Retirement Success in Maine podcast. Jami, thank you so much for joining us today.

Jami Aleksiev:

Thank you for having me.

Ben Smith:

Well, Jami, we have a lot to cover around Medicare, right? This is not just a very small question that we have to ask. There's lots of different angles, lots of different things. I know you're out there in the public routinely talking to people about helping them understand basic to advanced Medicare here. So we want to talk about that, but we also want to get to know you a little bit before we get into that. Love to hear about your experience growing up and what's been your connection to Maine.

Jami Aleksiev:

Well, I was born and raised right here in Bangor. I attended and graduated University of Maine. I've always worked here. So I'm a Maine girl.

Ben Smith:

Go Black Bears.

Jami Aleksiev:

Go Black Bears, and even attending Black Bear hockey games as a little girl with my dad. Maine roots grow very deep. Certainly traveled in other states and other countries, but my heart belongs right here in Maine. Although there's a few times, few days during the winter I wonder why I'm not moved to Florida yet, but maybe when I turn 65 that opportunity will be there, but-

Curtis Worcester:

I like that. Ben and I are both also born and raised Mainers here. So you fit right in with this conversation. I want to ask. Can you just talk about your path towards working for the Eastern Area Agency on Aging?

Jami Aleksiev:

Sure. As you said, I spent 13 years in the mental health field. I learned so much, and it's what my degree is in. Being in various roles, you gain so much experience, but I really found myself having to take a step back and needing something different in my career and needing to shift and take what I experienced and grew in and shifted over to another agency still working with adults because that is my passion. I knew about Eastern from my mental health background because I would transfer people over here for Meals on Wheels. When we do outreach, Meals on Wheels is one of the programs that people know us most about. I knew it was a great agency to work for. It's just the passion that I see and hear with the people that I work with, what we do for the community. It's just a great agency to work for.

Curtis Worcester:

For sure.

Ben Smith:

Nice. Well, Jami, one question we always like to ask is, again, people that we're bringing on we know are just passionate about what they do. They really love and they find purpose from their work life. So question I want to ask you is, what do you love about your job the most?

Jami Aleksiev:

Well, it's going to sound cliche, but I do enjoy talking about Medicare. When I first started training, I would tell people, "I'm going to make your eyes glaze over," but I could talk about it all day, but really, truly it's one of those positions where I get up and I enjoy so much what I do. It's that cliche saying of if you enjoy what you're doing, you're never going to work another day in your life. I really, truly feel that I've been lucky enough to find that position for me. It's been a great work-life balance. I come in, I'm able to enjoy what I do, work with the people that I work with, and then still go home and, yes, be that mom to my two kids.

Ben Smith:

Awesome.

Curtis Worcester:

That's awesome. I'm thrilled to hear you enjoy talking about Medicare because that's where we're going right now. So I want to rotate in and dig into we'll call it this experience of claiming Medicare benefits. I have a list of questions for you here. So I'll just go one at a time. So right off the bat, when should somebody reach out to Medicare to discuss claiming their retirement Medicare benefits?

Jami Aleksiev:

Typically, we tell people within six months prior to turning 65. We do have people that call here a year before they turn 65. There's really no wrong answer as long as it's prior to 65 because it's not something that happens automatically.

Curtis Worcester:

Got it.

Jami Aleksiev:

There is what's called an initial enrollment period, which is seven months that surrounds your birth month of turning 65. For people that are looking at retiring at the age of 65, it's crucial because a lot of people have employee benefits and employee insurance and you want to make sure there's no gap between your employment ending and your Medicare beginning.

Curtis Worcester:

Gotcha.

Jami Aleksiev:

So what we tell people is we offer what's called a Medicare 101 presentation a couple times each month. It's a free class that people can attend, and that's where we go over the basics of this is what you need to start doing when you need to start doing and how to start doing it.

Curtis Worcester:

Gotcha.

Ben Smith:

Jami, you make a really important point there because I think that's been a big question we've received is, "Hey, is it the year in which I turned 65?" So if December is my birth month and I'm turning 65 in that year, so your point, I want to make sure we got the highlighter on, is seven months around it, but also to your point about, "Hey, I'm going to retire in May," or "I'm going to retire," using that same example, "December, so I'm going to retire in February, then maybe I need to be thinking about coverages around those months after working maybe before Medicare." So I think those are really important points that you just brought up there. So I just want to highlight that.

Jami Aleksiev:

Yeah. Using December as an example, your initial enrollment, it would begin September, October, November, within those first three months prior to turning 65. So that's when Social Security looks at you as Medicare eligible. So those first three months you can call and your Medicare could begin December 1st. What's great for people to know is it doesn't matter when in December your birthday is, whether it's the second or the 27th.

Curtis Worcester:

Gotcha.

Jami Aleksiev:

If you call within those first three months, September, October, November, it begins December 1st.

Ben Smith:

Gotcha.

Curtis Worcester:

Gotcha.

Jami Aleksiev:

There are people that say, "You know what? I want to work until I'm 70," or "I'm not ready to retire."

Curtis Worcester:

Sure.

Jami Aleksiev:

There are two key words. It's called creditable coverage. What we tell people is even if you're Medicare eligible, you've turned 65 but you're not ready to retire and you have creditable coverage through your employer, you can get a letter that says your insurance is creditable coverage and whenever you're ready to retire, you can then call Social Security and enroll into Medicare without penalty because they could come back and say, "Well, what have you been doing for five years because for five years you've been eligible? What have you been doing for insurance when you could have been taking Medicare?"

Curtis Worcester:

Gotcha.

Jami Aleksiev:

You could present that letter of creditable coverage and say, "I've had employee coverage. That waves penalties," and then your Medicare will begin the next month after you officially enroll.

Ben Smith:

Great.

Curtis Worcester:

That's good to know. So back to my little checklist here. So we talked about when. So now, I want to talk about how. So how does someone go about scheduling an appointment with someone to discuss Medicare options, right? Do they reach out to Medicare directly or to an agency like E triple A and yourself?

Jami Aleksiev:

They can call 1-800-MEDICARE, but a lot of people like that face-to-face one-on-one contact or just they can call us directly and they're not going to have to push 10 buttons before you talk to a real person. They can call us, talk to a real person, and get some questions answered, and feel as though you get that personal touch of you're hearing me, I can tell you my story, my scenario and get questions answered, but for people in order to enroll into part A and B, you do have to call Social Security and enroll through them, but sometimes people call us and they say, "Okay. I know I'm turning 65 at six months. Where do I start? What's that first step?" We can break it down, send you back out to make those phone calls, come back in and we'll walk you through the next steps.

Curtis Worcester:

Awesome. Then just a technical question here. So I think that's certainly something I think that clearly people do it is reach out to you all and have that personalized experience. Is that consultation meeting? Is that something that has to be done in-person, right? Obviously, the last couple years we've all rotated to a virtual world there. So is that something that can be done, I know you referenced phone calls, is that in-person? How does that work?

Jami Aleksiev:

We offer appointments face-to-face or in-person by phone or by Zoom, where we cover four counties prior to COVID. We would go into the communities and meet with people at various locations for those four counties. Zoom's allowed us to continue those appointments through the pandemic, and we'll continue Zoom even after all of this has settled a little bit more, but for people that live in the area or they come to Bangor more frequently, they can choose to come into our office or we can just call them by phone and answer those questions that they have.

Curtis Worcester:

That's fantastic. In terms of those conversations and meetings, is there any cost or anything for anyone to reach out to you all to get that guidance?

Jami Aleksiev:

There's not. It's completely free. Anywhere from the 101 class that we offer to our appointments or counseling appointments, it's all free to the public. We tell people just because you come in once doesn't mean you can't call us again. Come in as many times as you need to or annually as you need to, and there's no cost.

Curtis Worcester:

Gotcha. Then the last question on my list, I know we answered the first half of it there in the beginning, but it's when does Medicare coverage start, right? So say, I'm turning 65 in April, want to claim. Does it start in the month in which I turned 65 or does it start in that year? Now, I know you just referenced that seven-month window there, but is there anything else there you want to explain further? Then if not, I can keep going, but go ahead.

Jami Aleksiev:

Sure. I guess one other thing for people to know is there are certain scenarios and there are so many. It wouldn't make sense to get into all of them right now, but there are what's called special enrollment periods.

Curtis Worcester:

Gotcha.

Jami Aleksiev:

So if there are various reasons, people can enroll under a special enrollment period as well.

Curtis Worcester:

Gotcha. Okay. Then the last piece of this question I had, so obviously, working with a benefit like Social Security, if we wait to claim Social Security, obviously, you can earn an increased benefit there, is there any benefit to using private insurance instead of Medicare? I know you talked about if someone continued working, for example. Can you mistakenly claim too early or too late? Is there any way to cause yourself harm there with the date in which you enroll?

Jami Aleksiev:

The biggest thing that we see is I'll use the example of you have a couple and one is turning 65. They've both been on the employee coverage and the coverage has been through the person who is turning 65 and they get onto Medicare.

Curtis Worcester:

Gotcha.

Jami Aleksiev:

The person, their spouse, who is let's say 62, they're not eligible yet. What are they left to do? A lot of times people will access Marketplace for those next couple of years. What we tell people is if you're enrolled in Marketplace and then you become Medicare eligible, there's nothing behind the scenes that makes that disenrollment-enrollment automatic just because-

Curtis Worcester:

Gotcha.

Jami Aleksiev:

... Marketplace and Medicare don't talk.

Curtis Worcester:

Sure.

Jami Aleksiev:

So if people are accessing subsidies through the Marketplace and then you become Medicare eligible, the penalty for that come tax season is pretty steep. So we tell people if you're on marketplace make and you have a start date for Medicare, make sure you're officially disenrolling, and then a few weeks later, call them back and double check that they disenrolled you.

Ben Smith:

I could see where that's really important and where people could just go, "Hey, Medicare, and I assume they're just going to take me off the Marketplace." By the way, you're receiving subsidies to be on the Marketplace and that could be problematic. So that's a really good tip there, Jami.

Ben Smith:

So I want to ask a question about, again, if I'm getting ready for Medicare, I don't know anything about it, whatsoever. Lots of alphabet soup, right? There's differences. I hear part A, part B, part C, part D. I got meta gap. I got things like that all being talked about. Can you just give me the 10,000-foot stratospheric view of what are all the differences between the parts and then what's this me meta gap that you hear about?

Jami Aleksiev:

Sure, absolutely. I can tell you previously to come into Eastern and not being trained in this. I remember thinking, "Why do we need so many parts? Why can't we just have it one thing?"

Ben Smith:

Yes, exactly.

Curtis Worcester:

Yes, exactly.

Ben Smith:

Now that I'm trained and I'm doing these interviews, it makes perfect sense. So it's a very valid question. So I guess the overview is you can really think of it as a bracket of how it breaks down. So Medicare, starting off, has two options. You have original Medicare and you have Medicare advantage. They're both under the Medicare program, but they don't cross over.

Ben Smith:

Under original Medicare, which I believe the majority of the people I want to say it's right around 80% of people in Medicare are in original Medicare. That's what they choose is best for them. Don't quote me on that, but I do know that the majority of people-

Ben Smith:

In your experience?

Jami Aleksiev:

In my experience, the majority picked that. So under original, you have part A, part B, part D, and a supplemental or what some people call a meta gap. Part A is what covers your hospitalization. Part B is what covers your outpatient services, your durable medical supplies, your flu shot, those types of things. Your part D is your prescription drug plan, and your meta gap is what covers the gaps of A and B.

Jami Aleksiev:

One of the more common questions people ask is, "Okay. If I have A, B, and D, why do I even need a meta gap?" What we break down for people is when we show them the gaps of A and B and really hone in on what the costs are and what the gaps are, it really opens their eyes and they say, "Yeah. Okay. Now I get why I need to carry pretty much a secondary to Medicare," because those costs can add up very quickly if something were to happen.

Jami Aleksiev:

Then the other side is the Medicare advantage. Sometimes people do call that a part C, but what Medicare advantage does is it takes A and B and D and it makes it all under one insurance plan. You get all of the services under one plan. For people that are on a Medicare advantage plan, you do not qualify for a meta gap. So those gaps of deductibles, co-insurances, copays are on your shoulders.

Ben Smith:

Gotcha. So it's really then on you to figure out those like, "Here's what makes sense for me personally for the risk I want take and also what I can afford and what's that there, right, essentially?

Jami Aleksiev:

Correct.

Curtis Worcester:

Yeah, and that's right where I want to go with my next question. So obviously, we want to talk about the cost of these coverages, and I know generally here. So what is the process to figuring out, I know you touched on it a little bit, you break down expenses, but how do I figure out what I need for coverage versus what that cost is going to be to me?

Jami Aleksiev:

Sure. Well, that's splitting it up still. It's looking at both original Medicare and then Medicare advantage. So with part A, your hospitalization, the premium for part A is free for people that have worked 40 quarters, and if people are unsure, that's a figure that you can get through Social Security by calling them or going on their website.

Curtis Worcester:

Got it.

Jami Aleksiev:

Essentially, 40 quarters equals 10 years of employment. Doesn't have to be full-time or part-time and it doesn't have to be consecutive. It's just 10 collective years of employment, and your premium is free, but with part A, going into those gaps, there are prices for a deductible. There's prices for inpatient costs. If people need to go to a skilled nursing facility, there's additional costs. If you haven't worked your 40 quarters, there are premiums, a premium price attached to that.

Jami Aleksiev:

So we tell people part A can actually get very pricey very quickly. I know when I do the presentation, I tell people, "This is the slide that you want to look at and let that ingrain in your brain because when we talk about meta gaps and you're questioning why I need this, this is why because if you go to the ER a lot or if you go into the hospital, those costs add up very quickly." For instance, inpatient I think is right around after 60 days is $389 a day. Skilled nursing facility, I think if you're in there after 100 days, all the costs are on you. So it's very pricey.

Jami Aleksiev:

Part B, your outpatient services, right now the premium is $170.10 a month. If people are higher earners, you're put on what's called an IRMA, and it goes up from there. So a single person, if they earn more than $92,000 a year, they're going to have a higher premium. For a couple that earn more than $182,000 a year, it's going to be a higher premium.

Curtis Worcester:

Gotcha.

Jami Aleksiev:

Then with part B, the costs, the additional costs are Medicare pays 80% of your part B, and then the person is responsible for 20%, which is another one of those gaps that a meta gap will cover. Part D costs can vary. I've seen premiums as low as $7 a month to a hundred dollars a month. Medicare.gov is a great tool that we use with people because you can plug in your prescriptions. You can pick up to five pharmacies and it breaks down what your pharmacy costs would be, and it really varies because the more common meds and generic meds are going to be very inexpensive, the inhalers or the newer meds are going to be pretty pricey.

Curtis Worcester:

Sure.

Jami Aleksiev:

Then meta gaps, it varies. We have in the state of Maine, I believe, 26 companies. It is very closely monitored by the Maine Bureau of Insurance, but we have various companies that can sell different types of plans, depending on what you're looking for coverage. Like with anything, if you want more coverage, it's going to be a higher premium.

Curtis Worcester:

Sure, sure.

Ben Smith:

So Jami, I want to go back to what you were saying here a little bit about that 40 quarters of employment. So I could see situations where, again, as financial planners working with people, there's enough situations where you had a couple and one of the spouse is working full-time and then one of the other didn't. Maybe they had children early on and they don't really have 40 quarters of employment. So when they get to 65, one of the couple has that already, but the other wouldn't, but essentially, so I guess what I'm just asking here is in that situation, that person then that doesn't have that level of a threshold, they haven't been employed for that duration for the rest of their life, really, if they're then, then retired along with their spouse, they're going to have then elevated. It's not going to be covered. It's not going to be free at that point to them. Even though, say, even their spouse passes away at some point, they still would have that cost, right?

Jami Aleksiev:

Well, actually, no. I'm glad that you caught this and asked this question because if somebody is married and they haven't worked 40 quarters, they can go off of their spouse's 40 quarters.

Ben Smith:

Okay. So yeah, just wanted to make sure that because I know there's lots of wrinkles when it comes to couples and especially when we had that with Social Security, that became a claiming on each other's and all that. So thank you for clarifying that part. I want to ask another question about cost, right? So we covered like here's some structures and cost drivers. One thing that we've seen when we have retirees and, again, a lot of what our show is in our podcast is, well, what do you want to do in retirement? What are the things that you always look forward to and the things that would actualize your retirement being more fulfilled, the things you always wanted to do, travel across a country?

Ben Smith:

So for example, I want to tap and do a retirement fund. I have a 401(k), an IRA, whatever, and I take a $100,000 out to buy the RV, and I know with inflation, maybe the $100,000 should be way more. So we want to do the fun things. I want to travel. I'm going to do all that now and I'm 66 years old, but what we've seen is these types of withdrawals generally increase their taxable income. Can you talk a little bit about how maybe increases in taxable income can impact Medicare premiums in the year that they take withdrawals or in future years?

Jami Aleksiev:

Sure. Yeah. I can see it really mostly impacting part B because of that higher earner. You might find that in that taxable year Social Security is going to come back and go, "Well, wait. Well, now you're going to be in a different income brackets and so for the next year, your premium is going to be higher." I mean, I certainly can't speak for Social Security, but if somebody were to come to us and ask, then we would say, "Okay. If they're going to put you in that higher income bracket, then you can talk about and say, 'Okay. Well, if I'm not going to do this again next year, then what is that going to look like about reducing back to that normal amount?'"

Jami Aleksiev:

As for the other parts and even the Medicare advantage side, off the top of my head, I don't see that would be an issue because, really, A is pretty much set in its hospital costs, D is really your prescriptions and your types of prescription is what drives the price, and meta gap is really the prices are already set by the company that covers them.

Curtis Worcester:

Sure. Yeah. That's very helpful. So what questions do you wish people would ask about Medicare that people typically don't know to ask?

Jami Aleksiev:

Well, I know I have to say I have to give a lot of credit to the people that we serve. They are full of questions. When we do presentations, you're always going to have a few of them that have just come in ready to ask every question, but I will say that one thing that we really wish that people would ask more about is the Medicare savings program. That's for people that are under a certain income guideline and under an asset limits. They can qualify for this program that helps pay for their premiums and it reduces their drug costs.

Jami Aleksiev:

There's a couple different levels, and the highest level actually prevents people from needing to get into a meta gap because all of your Medicare costs for the most part, not all of them, but a good chunk of it is paid for.

Jami Aleksiev:

Sometimes people, they hear that it goes through the DHHS eligibility and they go, "Okay. Well, I don't want anything to do with DHS." Well, it's a different program. It's not Maine Care. It's not Adult Protective Services. It's strictly a program that works with Medicare for people that are saying, "I can't afford ..." People sometimes come in and they say, "Okay. Well, I didn't realize Medicare was going to cost so much. I paid all my taxes all my entire life. I thought it was going to be automatic. It was going to be free," and that couldn't be further from the truth.

Jami Aleksiev:

So when they really start to look at the cost, they're going, "How am I going to heat my home? How am I going to pay for my mortgage? How am I going to put food on the table?" So that's where we take a step back and go, "Okay. So what's your income? What do your liquid assets look like? Help us help you, because we'll be more than happy to walk you through and submit that application process."

Jami Aleksiev:

So many success stories of people going, "Wow, I didn't know that this program existed and now I can heat my home. Now I can buy the Christmas presents for my grandkids. Now I can go fly out to Texas and see my daughter that I haven't seen in five years." That's what we wish that people would not feel that it's a judgment-free zone. We're here to help you, and that's what we want people to know that there's programs out there to help them.

Ben Smith:

So Jami, I think this is really helpful, especially from a, "Hey, I'm getting ready and I'm thinking about maybe the first time I apply for Medicare. I'm electing coverages," but, of course, then if you look forward the next year, the next year, there's enrollment periods is what we're understanding. So almost like what we're used to with the organizations we work with or for that there's enrollment periods for healthcare that's happening annually. So there's obviously as we age, we have to continue to assess where our health is, to what coverage we might need maybe projecting in the next 12 months, right?

Ben Smith:

So really, this is an annual review type process at the very least that we should be going through. So I guess my question to you is, Jami, how do you advise people to adapt their coverage as they age or as their medical needs changed? So do you see a pattern in what coverages? So again, I know we're talking broadly in a very stereotypical approach, but broadly, do you see a pattern on what coverages needed by age bands or by declining health?

Jami Aleksiev:

Well, we see a little bit of everything in the sense of once people learn more about Medicare and what to expect in the prices, that's when the wheels start to turn and they say, "Okay. Well, I travel a lot, and original Medicare I don't have to worry about in-network doctors. So that's going to be best for me." Back to the RV, "I want to go and do things." We ave people who are very healthy, they're going, "I never go to the doctor. I'm on very few meds. I'm willing to take the risk and do the Medicare advantage," because they could save money, and then they just know if something happens, "I have an X amount of dollar deductible," because we really hone in on, "What are your budgetary needs? What are your medical needs?"

Jami Aleksiev:

I also tell people there's no wrong answer because sometimes after a year or a couple of years, that make sense to be in a Medicare advantage plan. People are going, "I have a knee surgery coming up. My doctor's telling me I've got a hip surgery or there's cancer treatments I have to travel to Boston for." None of us have that crystal ball, so to speak, when it comes to our medical needs, but if somebody's in a Medicare advantage plan and they know that things are coming up and then that's going to be more costs on them, they can switch back over to original Medicare.

Jami Aleksiev:

If people start off in Medicare and then they're going, "You know what? This is a lot of money for premiums each month. I'm fairly healthy," you can go over to a Medicare advantage plan and you have to, it's biannual, and you can't switch whenever you want to, but there are certain enrollment periods to do that. So it really can benefit your needs. We have people that they're fairly healthy, they have a knee surgery, and so they like the Medicare advantage plan, but for the knee surgery, they go over to original and then they go through the nursing and the rehab and then they go back. When they're all healed, they go back to a Medicare advantage plan. You can somewhat cater it to your specific needs.

Ben Smith:

So Jami, is there examples where, again, I'm in a relationship, me and a nice spouse together, do you see situations where maybe one of us is Medicare advantage and the other one is maybe old Medicare because I'm thinking, "I have a surgery this year coming up," and I'm thinking about that, and I'm thinking about my out of pocket cost, but my spouse is healthier and doesn't anticipate any changes and might want to say ... So can you vary by person as well that way?

Jami Aleksiev:

Absolutely. In fact, you need to do that when it comes to Medicare because it's not a family insurance. It's not a one catchall. We do see spouses or couples that one is in Medicare advantage because for whatever reason and one has to be in original Medicare. We tell people, "You have to look at your own specific needs," because we all have various medical needs and we all are on different medications, and that's something that you have to contour to you.

Jami Aleksiev:

Sometimes people will call us and go, "Well, my neighbor or my husband or my coworker said this is a plan that works really well for them."

Jami Aleksiev:

"That's great. That's what we want to hear, but just because it works great for them doesn't mean that it's going to work great for you, and here are the pros and cons."

Jami Aleksiev:

One thing I didn't mention before is that we don't contract with an insurance agent or a company. So when people come see us, we're giving them unbiased education. Yeah. So we're going to break down the good, the bad, and the ugly. We're not going to steer you one way or the other. We're going to just take that information you're giving us and say, "These are your options. These are your choices."

Curtis Worcester:

I like that. I'm glad you clarified that point. I have a quick question as a followup to Ben's as well before my next one. So I know you mentioned in terms of people adapting or changing their coverage, I know it's an annual thing. Is there any restriction on, I know it's probably a strange hypothetical, but is there any amount of times you're allowed to switch or modify throughout your Medicare life, if you will?

Jami Aleksiev:

I would say I'm not going to give a flat no, and it's just because there's so many other deeper scenarios and eligibility, but for the most part, I would say if people really genuinely need to know or have a scenario that they want to run by us, just give us a call, but for the most part, we don't really see a lot of people switch because they can gauge what's going to be best for them. A lot of times, people are very quick to say, "I want this. I don't want that."

Jami Aleksiev:

With drug plans, there is an annual. It's our busiest time of year in the fall is the open enrollment period, and we actually tell people that even if things are going really well, you like your prescription coverage, you have no concerns, still call us and have us renew it or at least review it for the next year because part D changes more frequently than anything else.

Curtis Worcester:

Gotcha.

Jami Aleksiev:

You might find that your pharmacy next year isn't in-network or isn't a preferred pharmacy. So it always is going to behoove you to review that and see what's going to be best for you. We do see switching a lot back and forth and that's fine with part D.

Ben Smith:

So Jami, just following up to what Curtis just said, too, is getting on Medicare was part of it changing Medicare. So I guess I want to ask a question because this obviously happens for lots of people, is all of a sudden maybe their asset level may dictate that they might be eligible for something like Maine Care. I know we're in the state of Maine, of course, so getting to maybe a different level of coverage. So what's that process? I know what you said about, "Hey, I'm going from private insurance as I'm working and we need to unravel maybe Marketplace and over to Medicare," but what about the process of, "I'm on Medicare and maybe I think I'm now eligible for something like Maine Care"? What's that process to go from Medicare to like a Maine Care?

Jami Aleksiev:

So typically, what we see is people are already on Maine Care and then they're becoming eligible for Medicare. Okay. They way that it's looked at is Maine Care and Medicare are on the same level when it comes to coverage. So anybody who's on Maine Care and they're now eligible for Medicare, they're expected to switch to Medicare and then they can get on that Medicare savings program.

Ben Smith:

Gotcha. Okay.

Curtis Worcester:

Got it. All right. I want to go back to now my next. Sorry, we went on a little tangent there, but I think it was important. So obviously, a big part of all financial related conversations is this fear of fraud or elder abuse. It never seems to be going away. So I want to ask, how can people protect themselves from someone defrauding their Medicare benefit? It may be helpful if you could share examples of ways that people have been defrauded of Medicare. How does someone get defrauded from Medicare?

Jami Aleksiev:

Sure. We also contract with SMP or Senior Medicare Patrol. So fraud and abuse is something we're always doing in addition to Medicare. I've sat there when people have come in and said, "I just gave out my Social Security number and I don't know what to do," and your heart just goes out to them. Once again, this is a judgment-free zone. So we want people to come in. We certainly people feel that initial shame and we just want to tell people, "That's a human reaction, but come see us and let us walk you through it."

Jami Aleksiev:

We have a website. We have numbers that you can contact to help freeze your accounts, report that fraud, and help you on your way to make sure that it stops as quickly as possible. We are always telling people don't answer your phone if you don't recognize the number. If it's an important number and somebody that you do know and they just change their phone number, and whoever it is that they need to reach you, they'll leave you a message most likely.

Curtis Worcester:

Sure.

Jami Aleksiev:

I really always hate to give scammers credits, but they're really good at what they're doing because they're scammers. So we tell people that it doesn't matter your level of education. It doesn't matter where you came from. It doesn't matter what you did for a job. I've seen people who have great degrees almost getting scammed because with scammers, I remember going to a training, they said one of the things that they do is within that five to 10-second initial contact, they've already earned your trust. They have that wording just right to make it believable.

Jami Aleksiev:

So it's one of those things where you always have to be on guard. So it's going back to the basics. If you see an email that you don't know, don't open it. Don't answer the phone. Don't feel obligated to give out your personal information. Ask those questions, "Who are you? Why are you calling me?" or ask them what their number is and call back and see what you get. A lot of times, they're going to just hang up. We tell people don't give out your information. Just don't.

Ben Smith:

Yeah. So Jami, I guess the question is as well as because, again, to me it doesn't seem like an obvious question as how can someone get their Medicare benefit defrauded from them. I guess what I would maybe just ask off the top of my head, is it someone maybe filing a claim? They pose as you like, "I had knee surgery," and I'm saying I'm Jami and I submit a claim because I had your Social Security number and I said, "All right. Submit all this to Jami's profile." Is that where you would see someone being defrauded on Medicare?

Jami Aleksiev:

Sometimes. There are people that are using other Medicare numbers, not so much in Maine. Maine, scammers happen here, but you see it higher in other states, but yeah, sometimes people misuse Medicare numbers, and it was also one of the reasons why they switched a couple years ago from it being our Social Security numbers with an A at the end to a mix of letters and numbers so you're not just giving out or saying your Social Security number everywhere.

Curtis Worcester:

That feels like a good change. Yeah.

Ben Smith:

Yup.

Jami Aleksiev:

Yeah, yeah. It's another layer of protection, but that's why we also tell people to check your Medicare summary notices that it's going to tell you when you saw the doctor and what Medicare was billed for. We have pamphlets that we give out freely, no cost, that we tell people, "When you go to the doctor, jot that down so that you know on April 29th you went and had a physical, on July 17th you went and had a consultation about a knee surgery," whatever.

Jami Aleksiev:

So when you get your summary notices, you can compare them. We have had people that, and I used this example during our one-on-ones, there was a man who checked out his Medicare summary notice and saw that he was billed for hysterectomy. He's like, "Whoa! That never happened," and was able to report it.

Jami Aleksiev:

What they look at is also intense. Sometimes billing. We're all human. Human error happens. Sometimes you just need to say, "Hey, you billed this wrong," and the mistake is rectified. We had somebody who was going to be denied knee surgery because Medicare had been billed that he had already received an amputation and they're going, "Why would we pay for a knee surgery if you don't have any?"

Jami Aleksiev:

"Oh, it's still attached. It was billed wrong, and you need to fix that."

Jami Aleksiev:

So it's great for those to watch out for human error, which that goes under that umbrella of fraud, error, and abuse, but you're also keeping an eye on for any intentional fraudulent action.

Ben Smith:

Yeah. So Jami, I've gotten introduced to the Eastern Area Agency of Aging's executive director, Rebecca Kirk. She's awesome. She's really fantastic, a lot of passion for the organization just like you. So I can see where you guys fit pretty well together, but one of our questions here is, obviously, we're doing our financial plan because people save money over their entire lives. They're thinking about, "How long is my money going to last?" They're saying things like, "Obviously, Social Security and Medicare won't be there when I retire," right? So then they even think, "Well, I have to save even more," and they've been told, and this has been our experience, too, is that many company retirement plan discussions, they really talk employees in saving more into retirement accounts because they're told that there are going to be catastrophic costs in retirement and you're going to have all this out of pocket happening.

Ben Smith:

On a recent episode, we actually had a financial planning expert from T. Rowe Price come on, and he looked at all the data and he is saying, "Hey, the majority of time, that story isn't true," that it's really the people's healthcare cost is really contained to Medicare premiums, and then a little bit more modest out of pocket costs.

Ben Smith:

So I want to stress test that, right? He's saying, "Globally, here's what I see," but Jami, you're obviously talking to Mainers. You're the boots on the ground. You're giving the education. You're hearing what's happening. What's been your experience with the Mainers that you've counseled. Has that held true from it's really mostly that's what they're paying for or no, that's not true, what people are being counseled from their 401(k) or 403(b) providers are, yeah, there's major catastrophic costs happening that people are really paying for? What have you seen?

Jami Aleksiev:

I've heard that same lingo of that global of it's not going to be as catastrophic if the sky's falling type of scenario, but people are genuinely concerned, especially even when we have adults, children coming in with their parents and they're going, "Okay. I'm hearing what the costs are now. What is this going to look like in 10, 20, 30 years?"

Jami Aleksiev:

So it's hard to say. It's certainly something that it's projected that costs will go up. It's projected that the amount of people over the course of the next 20 years is going to be quite substantial of the amount of people that are going to be on the Medicare program, but it's a hard question to answer other than the fact that it doesn't go unnoticed. People are concerned, people wonder, but we also point back to we have to talk to the experts and listen to what the experts are saying that if globally that it's going be sustainable, then there's not much we can do, but I hate to say, wait and see, but let's wait and see and figure it out at that point and plan ahead as much as we possibly can.

Curtis Worcester:

Yeah. I like that. I want to ask a question. What are some of the most common mistakes that you see people make when they're new to claiming Medicare and then a follow up is, do you see mistakes happen more as someone ages maybe in going through that enrollment or re-enrollment process as they age?

Jami Aleksiev:

I think one of the more common ones is people assume. People assume it's going to be free. People assume it's going to be automatic. People assume their current coverage is going to be creditable. There was a person who I met with a while back who assumed that their coverage was going to be creditable and then five years later was hit with steep penalties because five years ago they should have enrolled. So I tell people don't assume anything. There's no wrong question. We'd rather overexplain and you overask questions than you walk away going, "Oh, well I don't ..." No. Ask those questions now. Let's get it out in the open. So we just tell people just don't assume anything. Come see us as many times as you need to and we'll walk you through. We'll crunch some numbers and do all that.

Curtis Worcester:

Yeah. No, I like that. That's, I mean, obviously, great advice and you guys are such a great resource that, I mean, now the time to use the resource instead of when it's too late. So want to change gears here, Jami. So we've reached the end of our conversation. We have one question left that we like to ask all of our guests. So obviously, the name of our show is Retirement Success in Maine podcast. So I want to ask you, how will you define or find or what is a successful retirement to you? So I guess fast forward to when you get to retirement age, what will be that successful retirement for you?

Jami Aleksiev:

For me will be a place, I'm at that place in my career. I'm looking ahead trying to save as much as I possibly can and looking at the here and now and years down the road. I guess being able to step away from a career that I'm proud of, passing it along to somebody who has just as much passion and can carry the torch, and being able to spend time with family and travel and the things that we all want to do, but do it in a way that's like with the retirement, as you guys know, it's that sustainability of you don't want to see that drastic drop of, okay, you're used to this life, but now you're going to have to make a lot of changes. It's how do you carry that over of, "This is the life I'm used to, and this is the life I want to continue to live," and that's what I'm shooting for personally so that you can relax and enjoy your life riding off into the sunset without feeling that financial strain.

Curtis Worcester:

That's great.

Ben Smith:

Jami, that's a great answer. We really can't thank you enough for coming in and really discussing the ins and outs of Medicare with us. Again, I know this is going to change every year and things are going to be added and moved and worked around, but I think what you really did successfully here for us today is really provide the structure of when somebody has questions, when they're trying to figure out what their situation is and what they should best do, where to go for advice, I think is the most important thing we wanted people to take away, and I know you really nailed that part for us today.

Ben Smith:

So Eastern Area Agency on Aging, again, has a really big footprint with four very large counties, but there's a lot of really great area agency on aging throughout the state of Maine, all of them you can contact doesn't matter where you're listening. That's a really great resource to use. So Jami, I think on behalf of all the area agencies on aging, I think you did a fantastic job representing it. So thank you so much. Love to connect with you maybe down the road when we can hear a little bit more about maybe Medicare 102.

Jami Aleksiev:

That would be great.

Curtis Worcester:

That's right.

Ben Smith:

So once we've graduated the beginner class, maybe we can go a little bit intermediate for you. So that would be excellent, but we will catch you next time. Thank you so much.

Jami Aleksiev:

Thank you for having me.

Ben Smith:

So we're really excited to have Jami Aleksiev on the podcast today from Eastern Area Agency on Aging. I just like to prove to myself I can say that because it's such a tongue twister.

Curtis Worcester:

I'm done saying that one. E triple A from here on out.

Ben Smith:

Yes, E triple A we learned today. We got to use the acronym there. It's way easier to say, but yeah, we really wanted to talk about Medicare and, obviously, there's getting off our own personal insurance or organizations or employers or going Marketplace and how do you transition back and forth, and also, what about traditional Medicare versus Medicare advantage, and going back and forth. Lots of things that continue to change. We obviously know when we did this show today that every year things are going to be a little bit different, right? There's going to be new things that are coming up. It's all very nuanced, but I think Jami did a really great job today of walking us through those changes and things that we should just be aware of.

Ben Smith:

Again, I think the biggest highlight is to say, "Hey, if you have questions and you really need help walking through it, there's people there."

Curtis Worcester:

That's right.

Ben Smith:

You can go reach out to do that. So I know we have resources we like to point people to. So Curtis, where can people go to find a little bit more information from today's show, but also getting in contact with E triple A?

Curtis Worcester:

Yeah, for sure. So obviously, we like to publish that blog website with all of our episodes. So that website is blog.guidancepointllc.com\65, episode 65. It's Medicare day around here. So yeah, on there we'll have, again, a quick summary of the show. We'll have resources there, obviously, contact info for E triple A, so medicare.org, medicare.gov, excuse me, links there. So feel free to check that out and, yeah, that's what we got.

Ben Smith:

Yeah. Well, thanks, Curtis. I know we wanted to just obviously thank Jami again for coming on. I think she did a fantastic job of walking us through where everything was at. Again, I think as financial advisors, these are things that we try to help where we can, but Medicare isn't our firsthand knowledge of what to do and how to do it and doing that. So again, we want to make sure it fits into our client's financial plans, but having experts like Jami that we can reach out to is really valuable and important. So we really appreciate everybody tuning in today. We really hope you're outside enjoying some of this lovely weather in Maine, and I know it's getting warm out. So go outside, soak up some sun and we'll catch you next time.