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Scott Webb: Let's be honest, Medicare can be a bit confusing between the different parts and enrollment in particular. It's probably best to consult with an expert. And joining me today is an expert to help us all understand Medicare and discuss the Aspire Health Plan, which may be a great option for Medicare patients is William Tienken. He's a health plan advisor with Aspire Health.

This is Ask The Experts, a podcast from Salinas Valley Memorial Healthcare System. I'm Scott Webb. William, thanks so much for your time today. We're going to learn more about the Aspire Health plan, and it's great to have you on to help answer some of these questions for folks. So as we get rolling here, what is the Aspire Health Plan?

William Tienken: Aspire Health Plan is a local trusted nonprofit Medicare advantage that is jointly owned by Salinas Valley Memorial Healthcare Systems and Montage Health. Aspire has set premiums regardless of age and your health status. Our Medicare Advantage Plan was created by leading doctors and hospitals in the Monterey County who wanted to give patients a better healthcare experience by joining their efforts together to provide a better healthcare option for those that are Medicare eligible. Each plan is designed to keep you healthy, coordinating your care from paperwork to prevention, to procedures. We have an entire team advocating for you when you need assistance.

Scott Webb: Yeah. And you mentioned Medicare there, and I think that's something that many of us are familiar with. So how does one become eligible for Medicare?

William Tienken: By your 65th birthday, you must be entitled to Part A and then you would enroll into Part B, which has a monthly premium. You would normally apply up to three months in advance of your 65th birthday and allowing you until three months after that to apply. This period is called the initial enrollment period. If you have earned your 40 quarters from working and paying taxes, which is at least 10 years, eight hours a day, full time, you will be entitled to a premium-free Part A. You would not need to apply if you are still working and have creditable employer's coverage and plan to continue work, or if you are already receiving your retirement pension from social security, then you will receive your Medicare automatically.

Scott Webb: Yeah. And I'm sure one of the questions that folks have is, are there financial penalties if we don't join Medicare? Like I think I, you know, heard that kind of floating around social media or otherwise. Maybe you can clarify for us. Are there financial penalties if we don't join Medicare?

William Tienken: Yes, there are. If you don't sign up by the allotted timeframe in your initial enrollment period and don't have any other creditable medical coverage. Like example, employer or even VA, you will be assessed a 10% penalty per month calculated annually for Part B and also a late enrollment penalty for not having a prescription plan.

Scott Webb: So it's obviously a good plan, good practice to make sure that we do this in a timely fashion during that window that you mentioned, or the three months before and three months after and not to exceed that to avoid these financial penalties. And is that when we select our Medicare options during that window?

William Tienken: Yes, that is. That's when you first select your Medicare options. Although there are other periods for you to select, that period that I just mentioned is the initial election period, is the most important one when you first turn 65. But what about all those people that already turned 65 and are wanting to change an option three years later, or two years later, what do they do? Well, there's an annual enrollment period that is every year from October 15 through December 7. This allows you to make changes and whatever choice you select will be effective as of January 1st of the following year.

Then what happens with all those people that, say, in the middle of the year decide to move from one county to another or lose insurance in the middle of the year? There are special enrollment periods. Certain exceptions will allow you to enroll outside of the annual enrollment period. For example, like I said, moving in from another county, loss of employer coverage or Medi-Cal status if you're a low-income person. Or if you are a low-income person, you can qualify for something called low-income subsidy, extra help with prescription medication that allows you to change in the first three quarters of the year. Or sometimes a company may shut their doors down and you involuntary lose your Part D plan, Medicare allows you to select a new plan in the middle of the year. And basically, these special periods, you have three months to make the change, one month before the event and two months after the event.

Scott Webb: Yeah. So it does sound like when it comes to Medicare, that they give us ample time, right? For that initial enrollment period, to make changes along the way. And you've mentioned Part A and Part B. And I think Part D, the D stands for drugs, but maybe you can take us through this a little bit. What are the options for Medicare?

William Tienken: There's three ways that people can select their coverage in the Monterey county. One, a lot of people have just original Medicare and then, you add a standalone Part D prescription coverage, and then that's all you have. Then, there is the traditional way that we always had here in Monterey county is original Medicare, plus you add a standalone Part D prescription coverage. And on top of that, you supplement Medicare with a Medicare supplement.

The other option is what we are offering. It's called Medicare advantage or Part C Medicare. So you would have original Medicare and then you just add the Part C. The part C Medicare Advantage includes all of the benefits of Part A, Part B and Part D all in one plan.

Scott Webb: Well, that's really interesting. And obviously, you can see the benefits for folks, right? Sort of one stop shopping, which I really like, because I was going to ask you, like what is the difference between original Medicare, Medicare Advantage and Medicare Supplement. But it sounds to me like what you're offering folks is a chance to sort of one-stop shop.

William Tienken: Yes, basically it is. The difference between all these three options are as follows, basically. Original Medicare is administered by CMS, Centers for Medicare and Medicaid Services. It provides coverage for hospitals, Part A, and medical through Part B under specified rules. You can choose any doctor or hospital that accepts Medicare without a referral. You can choose to add a Part D prescription coverage. You would be responsible for the Part A hospital deductibles and daily copays for extended days, plus the Part B medical services, a premium per month, annual Part B deductible, and then responsible for 20% co-insurance on most medical services, whether it's inpatient or outpatient. The providers must be affiliated to Medicare for service. And that's basically how Medicare provides you the coverage.

Then, when we compare that to like a Medicare Advantage plan, a Medicare Advantage plan will combine your Medicare Part A and B coverage and it includes a Part D prescription drug coverage, all wrapped into one plan known as Part C Medicare. It is administered through a private company, in this case known as Aspire Health Plan. The member then receives benefits that go beyond Medicare, such as routine chiropractic acupuncture, transportation, gym, over-the-counter benefits, even preventative dental, also offering you additional enhanced health benefits like dental, vision, hearing aids and more while giving you nationwide coverage through urgent care and emergency care. And the providers must be affiliated to Medicare and the Aspire Health Plan network for service. So basically, what you do is you pay one low monthly premium, and our plans do not have a medical or hospital deductible, so you're covered from the start. We have low copays and co-insurance, making your healthcare costs low and predictable and often save you substantial amounts of money compared to original Medicare. They also include a yearly maximum out-of-pocket. But a lot of people are under the impression that they no longer have to pay the Part B premium for Medicare. That's not true. The prerequisite to join a Medicare Advantage Plan is that you must have Medicare A and B, you're responsible for that. You must live in the service area of the plan. And of course, enroll in a valid enrollment period.

When we compare these two options to what they've always had here in Monterey county, which is the Medicare Supplement Plan. They're often called Medigap or MedSupp. There are different programs within different premiums that are affected by age and health status of the individual. All of them offer a standardized coverage throughout the MedSupp industry. It helps pay some of the healthcare costs that original Medicare does not cover. Restrictions do apply. It's an insurance policy without the extra services of a Medicare Advantage Plan that provides you with, and the providers must be affiliated to Medicare.

Scott Webb: Well, this has been really helpful today. No wonder, you know, folks would have a lot of questions, a lot of concerns, and this Medicare Advantage that we've discussed here today, the Aspire Health Plan, seems like a lot of great benefits. I'm sure folks may still have more questions. What's the best way they can reach you?

William Tienken: Well, the best way they can reach us is basically by either calling me. My number is 831-644-7407 or they can reach our main lines at 866-798-9356.

Scott Webb: Well, a lot of great information today, William. Thanks so much for your time. You stay well.

William Tienken: Thank you very much.

Scott Webb: And for more information about Aspire Health, please visit aspirehealthplan.org. And if you found this podcast to be helpful, please be sure to tell a friend, neighbor or family member and subscribe, rate, and review this podcast and check out the entire podcast library for additional topics of interest. This is Ask the Experts from Salinas Valley Memorial Healthcare System. I'm Scott Webb. Stay well, and we'll talk again next time.