Transcription:
Riverside Simplete: A New Approach to Healthcare

Gabby Cinnamon: Welcome back to the Well Within Reach podcast brought to you by Riverside Healthcare. I'm your host, Gabby Cinnamon. If you're 65 or older or have a loved one who is turning 65, you may want to listen up. The annual enrollment period for Medicare is coming. And if you miss deadlines, delay enrollment or choose the wrong plan, it can cost you money and access to the type of care you want.

Terra Mullins, Director of Community Outreach at Health Alliance is here with us today to explain what we need to know to make the best choices for our health and wellbeing in the coming year. Glad to have you here, Terra.

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Gabby Cinnamon: I'm back with Terra. Can you tell us a little bit about yourself?

Terra Mullins: Absolutely. Thank you for having me today. My name is Terra Mullins, like you had mentioned, and I've really focused on helping people better understand Medicare and find a plan that fits their needs. And our team really focuses on health and wellness education and connecting our communities with valuable resources. And I've been with Health Alliance for over nine years, came from the clinical side. So really understanding how people need to access their healthcare has become a very important topic for me. And so that ties me back to the whole aspect of connecting people with valuable resources and brings us together with our partnership with Riverside and creating a health plan that is specific to this community through our Simplete Medicare Advantage plans, where we're trying to provide benefits that help members be healthier, which in turn helps our communities thrive. And we know when you have your doctor and your health plan working together, you have a trusted partner beside you from start to finish.

Gabby Cinnamon: Why is this time of year so important for people who are eligible for Medicare?

Terra Mullins: Ah, very good question. This is a big time of year. It's a time when people start to get a lot of information in the mail, on TV, all kinds of varieties of contact because we're heading into the Medicare annual enrollment period from October 15th through December 7th. And October 1st is when we call it the curtain lifts. And so you're going to see what new plans are out there, but you can't enroll or change plans until October 15th and you have up until December 7th to do that. So that's a time where people can make changes to their plan for the upcoming year or choose to stay on their current plan.

But we do encourage everyone to use this time to review their current plan and assure that it fits their needs. Sometimes things change year over year, and you just want to take that time to look at what other options there may be or may be new additions that your plan has brought to you this year. And I think the biggest thing to take away is that when a person understands their plan options, they can actually get the best care that they need and, at a price that they can afford.

Gabby Cinnamon: Got it. Yeah. So kind of good to know, so that you're more in tune with deadlines and like knowing what's going on at this time of year. That's for sure a good thing. Let's start with the basics. For those of us who don't know, what is Medicare?

Terra Mullins: That's always a fun one. Whenever I'm meeting with people talking about it, I say, "Who gets excited about Medicare by raise of hands?" And I don't see a lot of hands, so I'm glad we're talking about this today. But Medicare is a federally-funded health insurance program comprised of four parts, and so you hear letters referred to, so it's A, B, C, and D. And a person can qualify for Medicare if they're 65 years of age or older or if they're under 65 and have a select group of illnesses or disabilities. Medicare's a primary way that people will get their needs met for healthcare needs in their retirement years. And so most times, people will enroll in Medicare between the three months before their birth date or the three months after their birth date or the month of their 65th birthday if they're not already receiving retirement or disability benefits through social security,

Gabby Cinnamon: You mentioned some letters, A, B, C, and D. What are the primary plan choices? Is that the same as the letters you mentioned? Or how does that work?

Terra Mullins: Yeah, let's dig into that one a little bit more. So Part A and Part B together make up original Medicare. Part C and Part D offer additional coverage and benefits beyond what A and B offer. And so Part A is the hospital insurance coverage that covers while a person's in the hospital for inpatient hospital stays, care and skilled nursing facilities, hospice care, and some home healthcare. So that's Part A. Then, there's Part B, which is the medical insurance and that covers preventative services, certain doctor services, outpatient care, and some medical Supplies. so there's two more letters, right? So Part C is Medicare Advantage, and that is an all-inclusive kind of alternative to original Medicare that covers all the services that you get under original Medicare, but often includes Part D for drug and other extra perks or programs to help members keep healthy. So that was the third one, but then we mentioned Part D. That one's pretty simple. Part D is prescription drug coverage. So think D for drug.

Gabby Cinnamon: Got it. Okay. And yeah, I think this is a good time to mention too, even if you are not turning 65 or maybe even if you're not close to that, you might have a loved one who's turning 65 or is thinking about changing their plans. So all of that information, I didn't know any of that. And so that's very helpful for you to be informed as well if you're helping them make those decisions.

Terra Mullins: Absolutely. And I think one of the things that we dig into a little bit more is that Medicare Advantage Plans that we refer to as Medicare Part C, it works a lot like the coverage that we've all been receiving as we've been working or a plan that we may approached under 65, where everything is all in one. So Medicare Advantage Plan has similar benefits to that individual or group health insurance plan. And it's a bundle that puts A, B and D and then the C extras all into one. So that way, it includes possibly additional coverages for vision, dental, hearing, extra health and wellness or care coordination benefits. Sometimes it'll include coverage for fitness activities and over-the-counter drugs. But it's important to know that a person, no matter what type of plan that they're picking, they pay their Part B premium for their Medicare, regardless of the plan that they pick. So that's something that as you're planning financially, you need to factor that in. You're going to pay Part B premium to Medicare, and then you can find a plan with a monthly premium, some start at even $0 a month. So that's the time of year to go out there and look and see what plan's out there that you might be able to find for $0 plus it has all the extras, and it also would have a limit on your out-of-pocket cost for your medical services. So that really kind of helps you understand and know what to expect for the coming year.

Gabby Cinnamon: Based on the things you said, I think I know the answer to this question. But overall, would you say that Medicare Advantage Plans are better than other Medicare plans?

Terra Mullins: It is very personal. So selecting your Medicare plan is going to be based on what your needs are. So I would love to say that, but I think it's important that a person take the time to consider what is a have to have and what is a like to have, and then make sure that they're looking at those perks. Medicare Advantage Plans can include that additional coverages for routine vision, dental, hearing, and specifically our Simplete plans in partnership with Riverside, through our Health Alliance program, includes features such as fitness activities, over-the-counter drugs. And then, if you live locally, you can also use the Riverside Health and Fitness Center for free. So you just want to look and see are these things that interest you and pick the plan that works for you.

People who like the health insurance that they've had from their employer when they were working, they might appreciate that one-stop shopping convenience of a more comprehensive plan like the Simplete plan has to offer. And Medicare advantage plans, like some of the ones through Simplete, often meet a wide variety of budget and client needs, wants and extras. So again, it's just going to depend on the person. And I think it's important that they navigate that through with an expert.

Gabby Cinnamon: Right. Everyone's individual, like you said. It's important to emphasize that. We're going to take a quick break before we get into more questions with Terra to talk about primary care at Riverside. If you're listening right now and don't have a primary care provider or looking to switch, visit docs.riversidehealthcare.org, or call 855-404-DOCS to find the primary care provider that's right for you.

Now, back to Simplete with Terra. What do Simplete members like most about their Medicare Advantage Plan?

Terra Mullins: When you're turning 65 and eligible for Medicare, you're thinking about more fun things in life. And so what they are focusing on is that it's a simpler, more complete healthcare experience with lower cost and less red tape, thanks to a streamlined relationship with healthcare providers and insurance like with Riverside. And that Simplete network is made up of leading Riverside Healthcare providers, who our members already know and trust. And we offer plans that allow you to see any doctor or hospital that accepts Medicare.

And I think one of the additional perks is care coordination that can meet a variety of different needs. If a person needs help with health coaching or smoking cessation or all those different things, they can be a partner and an extension of your provider's office and work with you. And that's all a part of the plan that you're already covered through. And then, you're going to have coverage for hospital, doctor and pharmacy all bundled into one, and it can absolutely be more affordable than a Medicare supplement plan.

Gabby Cinnamon: It's crazy to think the year is almost over. We're almost three quarters done. What changes are coming for 2023 to these plans?

Terra Mullins: Perfect time of year to talk about that. So we are offering even more benefits, lower costs and less red tape to make sure that it's a simple and complete experience. And through our Simplete Riverside plans, we actually offer plans as low as $0 a month. That includes dental, vision and hearing. It also has virtual health coverage, because I know, as we've lived through our past couple of years here, virtual health experiences have been very important to our members. So virtual health coverage, as well as over-the-counter drug discount programs for people to have access to.

And then, we talked about the fitness benefit. So fitness and healthy lifestyle benefit for people to utilize is one of our perks built into the plan. But I think the biggest one that everyone's going to be pretty excited about is dental. So we have increased our dental benefit to $2,000 per year for services that original Medicare doesn't cover. So that's a change from last year and we know the importance of preventative maintenance when it comes to a healthy mouth. You wouldn't think that it ties to all kinds of other health-related issues, but it really does. So we offer a hundred percent coverage for what we call the class I routine dental care. And this includes cleanings, exams, x-rays and more. We also cover services beyond just that routine preventative, things like fillings, crowns, root canals, dentures, implants, those types of things, which can be pretty costly. So it's nice to see that the dental benefits going up. And these services are covered with a cost sharing up to the annual maximum. And then, there's some other perks because there's not a dental network, so you don't have to worry about which one you're going to. You can go wherever you would like.

And then, this one's really been surprisingly well represented with this new benefit that we're offering, which is a companionship benefit, which provides up to 30 hours of in-home support yearly through what we call our Papa Pal Program. And that gives services to our members to access a friendly companion who can help with a variety of tasks. Maybe you just need somebody to come in and help with a little light house cleaning or someone to accompany you to go get groceries or things like that. We've tried that benefit out in a different area and it's been really well received. So that's a new one coming to the plan this year. And then, ultimately just continuing to focus on keeping our members healthy and not just supporting them when they're sick or when they need to go see the doctor.

Gabby Cinnamon: Those are all very exciting changes to hear. That's awesome for people to get all these new things and stuff. So how do people get more information? You've given us a lot of information today, which is awesome, but if people want to get more information or sign up during Medicare open enrollment, how do they do that?

Terra Mullins: Sure thing. So just as a reminder, open enrollment runs from October 15th through December 7th, but you can start looking as early as October 1st and having conversations with people. You're welcome to contact a Simplete representative by phone, which is at 1-877-642-4753 or simplete.org online. And you can also work with a local agent or broker, who's contracted to sell the plans. So if you know somebody here locally that you know and work with, you can talk with them about the plans. And then, an additional resource could be your local SHIP counselor, so a senior health insurance program point person that can help you navigate all the plan options available to you. So any of those resources would be able to help during this important time.

Gabby Cinnamon: When we have a lot of choices, sometimes it can be overwhelming. And what would you say to someone who's overwhelmed about even getting started? And does Health Alliance have any additional support that they can provide people who are feeling a little bit overwhelmed by everything that's out there for them?

Terra Mullins: Absolutely. So, you know, whether people are personally shopping for a plan or assisting a family member with a Medicare decision, we are really just a phone call away and can help navigate and answer those questions. It is true that one size does not fit all when it comes to Medicare coverage, so we are happy to help people find plans that fit their health and wellness needs to match their lifestyle. So don't stress and turmoil out there. You can partner with us. We're happy to help. And then, like I said, you can partner with a broker or a SHIP counselor too, if needed.

Gabby Cinnamon: Thank you so much for all this information today, Terra. And thank you so much for coming on the podcast. It was awesome to have you.

Terra Mullins: Thanks for having me. It was a good time.

Gabby Cinnamon: This is going to help a lot of people. And thank you listeners for tuning into Well Within Reach. Make sure to leave a review on Apple, Spotify, or wherever you listen to our podcast. To learn more about Riverside Simplete, visit riversidehealthcare.org/simplete.