Just because you’re currently enrolled in Medicare doesn’t mean you have the plan that best fits your circumstances. Now’s the time to review your options and, if desired, make a change. Anyone who has Medicare part A and part B can enroll, disenroll or change their Medicare Advantage Plan during Medicare Open Enrollment, from October 15th through December 7th.
In this podcast, Joe Valenzuela, a Licensed Agent with Vista Mutual Insurance Services who works with MarinHealth partner Canopy Health, explains why it’s a good idea to review your coverage each year. He also discusses some of the circumstances under which a change would be recommended or required. So, before you decide to just stay with the plan you have, tune in for some additional perspective.
Selected Podcast
Medicare and Open Enrollment: What are my options?
Featured Speaker:
Joe Valenzuela
Joe Valenzuela has been in the industry for 14 years and currently manages 10 agents all of whom focus exclusively on Medicare. He worked for WellPoint for 5 years, (with the highest closing ratio on the sales team), and was one of the top agents at Humana for 6 years. He has 7 years of experience presenting sales and educational seminars for a major IPA in Contra Costa County. Transcription:
Medicare and Open Enrollment: What are my options?
Bill Klaproth (Host): It’s Medicare Open Enrollment season. And I know you have a lot of questions and a lot of things to research and a lot of things to do; so, what are your options? Let’s find out with Joe Valenzuela, a Licensed Agent with Vista Mutual Insurance Services.
This is The Healing Podcast brought to you by MarinHealth. I’m Bill Klaproth. Normally we’d be speaking with a physician but today, we’re going to talk with Joe who is a Licensed Agent with Vista Mutual Insurance Services. His company works with MarinHealth partner Canopy Health and is here on the podcast to help you make the decisions when selecting an insurance provider and there’s a lot of ground to cover when it comes to Medicare. Joe, thank you so much for your time. It is great to talk with you. Can we start by hearing some brief background on yourself?
Joe Valenzuela (Guest): Sure. Thank you so much for having me. My name is Joe Valenzuela. And I am the co-owner of Vista Mutual Insurance Services. And I’ve been in the Medicare space for about 14 years, specializing in only Medicare insurance.
Host: That sounds good Joe and we’re glad that you’re with us. So, it is Open Enrollment season. Are the dates for Medicare Open Enrollment the same as commercial open enrollment?
Joe: They are not. So, commercial open enrollment can be whenever they deem it necessary, however they set their plan. Medicare Open Enrollment begins October 15th and goes until December 7th. So, we can talk about plans starting October 1st but the first day that somebody can enroll is October 15th of any year.
Host: So during this Open Enrollment period Joe, is it then a chance for someone to change their physicians and Medicare insurance like you would before you had Medicare?
Joe: Yes. That’s exactly what this period is for. You can actually change your physician at any time during the year if it’s associated with your current plan. But if you’re looking for a different plan, or different doctors that are not associated with your plan, now is the time to look to change.
Host: So then what are someone’s opportunities to make changes? What can they do?
Joe: Anyone who has Medicare part A and part B, can enroll, disenroll or change their Medicare Advantage Plan during the annual election period.
Host: And then what about annually, every year, what are the options or what things should people look at to change annually?
Joe: Really, all of their options. Their current plan can change each year as well as other plans in the marketplace. Also, new plans can get introduced each year. So, you should have a full review annually during the annual election period.
Host: And then what happens if their benefits change during the year?
Joe: Yeah Medicare Advantage plans are year to year contracts. So, it’s very rare that benefits would change during the year. There may be network or covered medication changes but as far as benefits, they stay the same throughout the year.
Host: And then what happens if a physician stops taking a specific plan; then what do you do?
Joe: Yeah, this does happen although it’s rare as well. But if it does, they get a special election period to either select new insurance or they can select a new doctor under their current insurance.
Host: Okay so, if someone moves, can they change insurance providers then?
Joe: They can. So, if they have a Medicare Advantage plan and they are only offered in specific counties, so if they move out of their county; they would lose that coverage and then have a special election period to enroll in new coverage in their new county. But if they moved inside their county, they would not have this option as they would not have lost anything.
Host: Right. So, Medicare Advantage is basically Medicare part C, so can you change all parts A, B, C and D or only some?
Joe: Effectively, you can change all parts. So, part A and B are considered original Medicare and part C, like you stated is Medicare Advantage. So, if you join a Medicare Advantage plan, it takes over and becomes the primary insurance over Medicare. You still have Medicare and you still pay for it, but the Medicare Advantage plan administers your coverage through the private insurance company that you selected. So, effectively, yes you can change all parts.
Host: So Joe, this sounds like something everyone should review every year instead of kind of a set it and forget it attitude and let it roll for five years. What should a Medicare participant do each year to ensure that they are getting the right coverage for their needs? It sounds like that would be smart to do every year.
Joe: Definitely it would be, yes. You definitely need to have a review of your coverage with a local knowledgeable Medicare insurance agent and of course, at no cost to you. Insurance agents don’t cost you anything. Because things change annually, and new things come into the marketplace.
Host: So, since things can change annually, does coverage or options change anytime after you first enroll for example, costs going down if you get older or going up?
Joe: So, with a Medicare Advantage plan, they are year to year contracts so, yes, they are going to change each year. They can go up; they can go down. If you had a Medicare supplement which is another way to get insured, then it’s going to go up annually with your age as well as once a year for their annual increases.
Host: Okay. So, then are there things we should look for to compare to consider?
Joe: Definitely. So, healthcare is incredibly personal. It’s not a one size fits all type of product. You really have to consider what your specific needs are and get the health coverage that fits those specific needs. So, working with an expert adviser like an insurance agent that deals with Medicare can help you get the most coverage for the least amount of cost for your specific needs.
Host: So, it sounds like someone should meet with a counselor or an adviser like you annually to ensure that the coverage still fits their needs and see what can be changed.
Joe: Yeah, our licensed insurance agents, they have to get tested and certified on every product each year. So, we’re up to date on the changes before they even hit the marketplace. So, plans definitely will change each year and it’s imperative that you sit down with your provider to know what your changes are and what the new options are.
Host: So I think I heard you say earlier, you don’t charge for your services.
Joe: Never. We are a no cost to our clients. Some people think about travel agents or things like that that have to pay a fee. We’re compensated by the insurance company to educate, enroll and service you. So, you pay the same for your insurance regardless of how you sign up for it and if you go with an agent like myself, or one of my agents; you get all our expertise for no cost.
Host: That is really good. So then what is the best time to assess your Medicare coverage each year? Is it before Open Enrollment?
Joe: Usually I would say yes to that with traditional insurance but the Center for Medicare Medicaid Services states that product information for the next year can’t be released until 10/01 so, we call that pre annual enrollment period 10-1 to 10/15. We can talk about product information, but nobody can enroll yet. So, that’s a really good time to see what’s out there and see which direction you want to go. Anytime between 10/1 and December 7th.
Host: Joe, this has really been interesting. There are so many components to this and so many things to know. Podcasts like this are really informative. And thank you so much for sharing your knowledge with us. We really appreciate it. Thanks again.
Joe: Oh yeah, thank you so much for having me.
Host: That’s Joe Valenzuela and to learn more, please visit www.mymarinhealth.org. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is The Healing Podcast brought to you by MarinHealth. I’m Bill Klaproth. Thanks for listening.
Medicare and Open Enrollment: What are my options?
Bill Klaproth (Host): It’s Medicare Open Enrollment season. And I know you have a lot of questions and a lot of things to research and a lot of things to do; so, what are your options? Let’s find out with Joe Valenzuela, a Licensed Agent with Vista Mutual Insurance Services.
This is The Healing Podcast brought to you by MarinHealth. I’m Bill Klaproth. Normally we’d be speaking with a physician but today, we’re going to talk with Joe who is a Licensed Agent with Vista Mutual Insurance Services. His company works with MarinHealth partner Canopy Health and is here on the podcast to help you make the decisions when selecting an insurance provider and there’s a lot of ground to cover when it comes to Medicare. Joe, thank you so much for your time. It is great to talk with you. Can we start by hearing some brief background on yourself?
Joe Valenzuela (Guest): Sure. Thank you so much for having me. My name is Joe Valenzuela. And I am the co-owner of Vista Mutual Insurance Services. And I’ve been in the Medicare space for about 14 years, specializing in only Medicare insurance.
Host: That sounds good Joe and we’re glad that you’re with us. So, it is Open Enrollment season. Are the dates for Medicare Open Enrollment the same as commercial open enrollment?
Joe: They are not. So, commercial open enrollment can be whenever they deem it necessary, however they set their plan. Medicare Open Enrollment begins October 15th and goes until December 7th. So, we can talk about plans starting October 1st but the first day that somebody can enroll is October 15th of any year.
Host: So during this Open Enrollment period Joe, is it then a chance for someone to change their physicians and Medicare insurance like you would before you had Medicare?
Joe: Yes. That’s exactly what this period is for. You can actually change your physician at any time during the year if it’s associated with your current plan. But if you’re looking for a different plan, or different doctors that are not associated with your plan, now is the time to look to change.
Host: So then what are someone’s opportunities to make changes? What can they do?
Joe: Anyone who has Medicare part A and part B, can enroll, disenroll or change their Medicare Advantage Plan during the annual election period.
Host: And then what about annually, every year, what are the options or what things should people look at to change annually?
Joe: Really, all of their options. Their current plan can change each year as well as other plans in the marketplace. Also, new plans can get introduced each year. So, you should have a full review annually during the annual election period.
Host: And then what happens if their benefits change during the year?
Joe: Yeah Medicare Advantage plans are year to year contracts. So, it’s very rare that benefits would change during the year. There may be network or covered medication changes but as far as benefits, they stay the same throughout the year.
Host: And then what happens if a physician stops taking a specific plan; then what do you do?
Joe: Yeah, this does happen although it’s rare as well. But if it does, they get a special election period to either select new insurance or they can select a new doctor under their current insurance.
Host: Okay so, if someone moves, can they change insurance providers then?
Joe: They can. So, if they have a Medicare Advantage plan and they are only offered in specific counties, so if they move out of their county; they would lose that coverage and then have a special election period to enroll in new coverage in their new county. But if they moved inside their county, they would not have this option as they would not have lost anything.
Host: Right. So, Medicare Advantage is basically Medicare part C, so can you change all parts A, B, C and D or only some?
Joe: Effectively, you can change all parts. So, part A and B are considered original Medicare and part C, like you stated is Medicare Advantage. So, if you join a Medicare Advantage plan, it takes over and becomes the primary insurance over Medicare. You still have Medicare and you still pay for it, but the Medicare Advantage plan administers your coverage through the private insurance company that you selected. So, effectively, yes you can change all parts.
Host: So Joe, this sounds like something everyone should review every year instead of kind of a set it and forget it attitude and let it roll for five years. What should a Medicare participant do each year to ensure that they are getting the right coverage for their needs? It sounds like that would be smart to do every year.
Joe: Definitely it would be, yes. You definitely need to have a review of your coverage with a local knowledgeable Medicare insurance agent and of course, at no cost to you. Insurance agents don’t cost you anything. Because things change annually, and new things come into the marketplace.
Host: So, since things can change annually, does coverage or options change anytime after you first enroll for example, costs going down if you get older or going up?
Joe: So, with a Medicare Advantage plan, they are year to year contracts so, yes, they are going to change each year. They can go up; they can go down. If you had a Medicare supplement which is another way to get insured, then it’s going to go up annually with your age as well as once a year for their annual increases.
Host: Okay. So, then are there things we should look for to compare to consider?
Joe: Definitely. So, healthcare is incredibly personal. It’s not a one size fits all type of product. You really have to consider what your specific needs are and get the health coverage that fits those specific needs. So, working with an expert adviser like an insurance agent that deals with Medicare can help you get the most coverage for the least amount of cost for your specific needs.
Host: So, it sounds like someone should meet with a counselor or an adviser like you annually to ensure that the coverage still fits their needs and see what can be changed.
Joe: Yeah, our licensed insurance agents, they have to get tested and certified on every product each year. So, we’re up to date on the changes before they even hit the marketplace. So, plans definitely will change each year and it’s imperative that you sit down with your provider to know what your changes are and what the new options are.
Host: So I think I heard you say earlier, you don’t charge for your services.
Joe: Never. We are a no cost to our clients. Some people think about travel agents or things like that that have to pay a fee. We’re compensated by the insurance company to educate, enroll and service you. So, you pay the same for your insurance regardless of how you sign up for it and if you go with an agent like myself, or one of my agents; you get all our expertise for no cost.
Host: That is really good. So then what is the best time to assess your Medicare coverage each year? Is it before Open Enrollment?
Joe: Usually I would say yes to that with traditional insurance but the Center for Medicare Medicaid Services states that product information for the next year can’t be released until 10/01 so, we call that pre annual enrollment period 10-1 to 10/15. We can talk about product information, but nobody can enroll yet. So, that’s a really good time to see what’s out there and see which direction you want to go. Anytime between 10/1 and December 7th.
Host: Joe, this has really been interesting. There are so many components to this and so many things to know. Podcasts like this are really informative. And thank you so much for sharing your knowledge with us. We really appreciate it. Thanks again.
Joe: Oh yeah, thank you so much for having me.
Host: That’s Joe Valenzuela and to learn more, please visit www.mymarinhealth.org. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is The Healing Podcast brought to you by MarinHealth. I’m Bill Klaproth. Thanks for listening.