001hi I'm Mar B run and the presentation you're about to see is the one that we I had pre-recorded for showing in Ashland uh in November this is all about Medicare it's Medicare time it's open enrollment and what what I try to do in the presentation is give just give you a way of thinking out how to reexamine how your plan currently works and whether or not it's going to work for you again next year either because your health has changed or because your plans may have changed and when you're thinking about that I always encourage you to work with somebody uh one of the shine counselors at the senior center these are folks who are are either staff or volunteers who have been who are trained specifically to let you know how these plans
002have changed for uh 2024 and whether or not it would be to your advantage to change anything in your plan so I hope you enjoy the presentation if you have any questions please give me a call 508 8601 1470 thank you hi I'm I bridon and welcome back to elder law 101 uh the seminar series that I developed uh and and presenting in 11 or excuse me in 12 separate episodes one a month uh and the goal the of elder law 101 is to take all of the seminars that I've done in the past and to package them in a way so that you could kind of see through your whole life well even from before you were a senior but through your life as a senior uh what the issues are that you need
003to be thinking about the purpose of these seminars is not to get all of the answers uh the purpose is to make sure that you understand that there are questions that may need answers so that you can talk about to someone about your individual situation so um we've been doing these uh presentations now through the year we're up to number 11 it's actually November right now uh in the first presentation we talked about uh in we always talked about my friends Frank and Mary um and their kids Peter Paul and Mary Jr we T we kind of follow them through their lives in the first presentation we talked about incapacity in estate planning before age 60 uh which has its own set of issues to it your children are typically then younger you're then younger
004your sense of health issues is very different we talked about things to consider in the next seminar in your 60s uh where we talked a lot about social security um we talked about the the fact that you can now start pulling out your deferred income funds we did not talk in that seminar uh at all uh about Medicare because I held that conversation for today because it's really a separate conversation we talked about dealing with life in your 70s which is often a time where you're thinking about changing where you may be down thinking of downsizing or having somebody move in with you or you're just a bunch of different and you're kind of anticipating now how you're going to deal with with older age I talked about um dealing with uh taxes specifically this
005was way back in April uh because that's that one that like Medicare is really a specific topic then I talked about dealing with life in your 80s if you're a senior um often times that's a time when you've got some health problems you've got a whole bunch of different issues to face among others Mass health uh I took did a SE separate summon out to just talk about why it is that you can always qualify for Mass Health um and by the way when I say that I always have to emphasize it's why you can always cry for Mass Health not if you're unless you're in the community and have high income uh if you if you need nursing home care or you need a lot of Care at home in order to avoid going
006to a nursing home then you can always qualify for Mass Health uh I to do a separate seminar specifically on the last year of your life uh that's a year that can be uh obviously you know a depressing time a stressful time and the question is you know how do you kind of prepare yourself to deal with that uh I do a I talk about your your your planning after you're dead what what needs to get done following your death uh whether it's just through a state Administration I do was did a separate seminar on trusts I know they I know that they we're always talking about them the question is how do they work what are the different kinds of trusts there is trusts are meant as an answer to a qu to a
007problem the question is what's the problem and and what is the correct answer I um last month I talked about what to do about the kids and the grandkids if you're doing your estate planning you have some specific questions about um before or after you have died you know what are the what are the things you want to consider when you're giving things to your children or to your grandchildren um then finally today uh and by the way this is the 11th of 12 in the final uh presentation we're going to talk about giving which is a common topic uh in December uh but also about uh tax planning which is not necessar necessarily as common a topic but is really important to you as a senior especially if you have tax deferred funds so
008today we're talking about Medicare uh and and I want to emphasize and we're going to talk about once again we're always talking about our friends Peter Paul and Mary Jr uh or excuse me our our friends Frank and Mary and their kids Peter Paul and Mary Jr and by the way this topic is feeling very relevant to me uh I'm 73 and I'm in generally good health but last Saturday pulled out my back now this is I pulled out my back that's been happened certainly a number of times over the years but it's now a week later and I'm still having problems with my back this is not an the way it would have been you know 20 or 30 years ago so suddenly I found you know I talk need to talk to my
009doctor and I've got some meds and so you're dealing with this whole set of issues which are just inherent to becoming a senior so if you're Frank and Mary uh during your lifetime if you were when you were Frank and Mary and you were like 40 and Peter Paul and Mary Jor were 10 8 and six you had a very different kind of sets of concerns about what kind of insurance you needed because the real Medicare is Insurance uh and like house insurance and auto insurance so what is Insurance it is it is a payment that you're making to somebody uh as a premium in order to make sure that if an an emergency happens if something bad happens you're going to get something in return so if you're Frank and Mary and you're 40
010the question is well what will you know what if the house burns down we need something we need to make sure that's covered what if I get into a car accident what if I get hurt what if I hurt somebody else um well if what if one of the kids gets hurt how do I kind of deal with that and will one of us die suddenly when you're 40 you're really not thinking about illness you're thinking about the possibility of sudden death certainly illness sometimes happens but it's rare um when you're 40 um when you're 60 however uh or 70 or 80 um and your kids are grown up uh the the cluster is a little different certainly you want to still make sure that your house is was okay if it burns down and
011but you're also very concerned about will I die tomorrow you get to a certain age uh I think I had mentioned in an earlier seminar I had um earlier this year my third Tia uh uh which is a mini stroke uh it it it is very um enlightening to go through that because you come to realize at the moment at which your arm is getting numb and your leg is getting numb that this might be it right I might be dead right so so you know you you get a concern about will I at some point I'll die what happens if I die suddenly but even worse for most people what if I get really sick certainly there's an issue about what what what happens if there's a car accident although that's much rarer the
012older that you get through the real question is what happens if I get really sick um because there are a whole cluster of problems around that that right uh and there are all expenses that you may not have the cash to take care of the hospital the ambulance the doctors the physical and physical and other therapists the drugs right you know what what to do about all of those problems that's a real concern as you get to be our age the answer uh of course uh for many uh is Medicare um the point of Medicare it's hard to believe now kind of the point of Medicare is really is really embodied in this statistic that in 1960 uh 33% of seniors uh lived in poverty uh in 2 2020 6% of seniors live in poverty
013most of that is because of Medicare uh it's because you had people who would get older could not qualify for traditional Insurance were old and so forth though so they would get sick and they would die right and and and and and that sickness often would not be covered and so often times they would get sick and then they would just be stuck going bankrupt because they had gotten sick uh so Medicare was meant to solve that and it has to a tremendous extent I know seniors that I speak to are regularly really stressed about what it's going to cost for them to live for the rest of their lives um and they and they talked to me a lot about uh nursing home coverage um and trying to deal with that if they ever
014need it the reason for that is that is the one major medical expense that is not covered uh by Medicare for other expenses they kind of don't even think about it the you know the doctors and the hospitals and now even the drugs which were a tremendous drain on people's resources and still are to some extent but nothing like what it was before Medicare Part D had been adopted so there is traditional Medicare let me just I just want to talk about the pieces of the insurance puzzle that you need to solve in order to try to get a good night's sleep knowing that your finances are going to be okay if you get sick so tradition Medicare the wonderfulness of it is you don't pay a premium at least not for Medicare a Medicare
015A and originally uh Medicare historically was created through an incredible lobbying effort by the American Hospital Association because they were realizing the the tremendous cost to them and to their structure of dealing with seniors who had no resources because they had had you know a moral obligation to deal with seniors um and also they were typically nonprofits uh 501 c3s and therefore required to provide free care and it was bankrupting a lot of these places so Medicare A was designed especially to take care of hospitals so uh in Medicare Medicare A provides for um uh covers your hospital expense from admission uh there is a deductible um and and there is a maximum number of days in the hospital um basically you go to the hospital um and initially the the there's an initial um
016deductible then you're therefore you can be there at the hospital if I recall correctly for up to 60 days per um Medicare stay before you dip into your lifetime number of available extra days that you can stay in the hospital and without going through the whole system the point is Medicare A is designed to cover hospital stays however there is a there is a copay um if you are have been in a a hospital for a short Peri at least a short period of time and then get discharged from the hospital directly to a nursing home then Medicare will also cover up to 100 days in the nursing home uh but uh very seldom does uh Medicare typically covers 17 days in the uh nursing home one of the reasons for that is uh that
017me Medicare um well to be honest I think one of the reasons for is that Medicare uh reimbursements to the nursing home uh go down substantially uh if it is unless it is shown that the that the care that is being given uh is improving your situation uh consistently and so um Med the the the the uh nursing homes themselves uh often are not really interested in your staying on nursing home for a prolonged period because the reimburse rates go down so much so Medicare will cover up to that 100 days in skilled nursing uh it also covers um this special program which by the way you know you should become aware of uh and talk to the shine counselor or your doctor or others about just in case you need it which is the
018program that is available for folks who are at home um but are Homebound and therefore uh cannot leave the home in in order to get other services at the hospital or at their doctors or whatever so that's the the point of the the program and the way the program works is that if your doctor certifies that you need this program then the program is available to you for in in 60-day increments um but those in and that will cover during that period nursing care not home care not just regular non-skilled Home Care uh but nursing care and a set of other benefits and that that 60-day period can be renewed uh uh for forever you could L literally just keep using these 60-day increments um for as long as you live then there is the
019hospice benefit the benefit that I really like to promote and encourage people to understand it's the benefit that is available for those folks who are living um um in a situation where uh the the they are not thinking that the care that are not designing their medical care in order to have them get better uh they're not um looking to improve they're not they don't have a kind of disease or they're not in a situation where things are going to get better for them they're really in a situation where they want to be they want care that will help them to live every day as well as well as they can um um for as long as they can but the main thing is to make sure that every day is good um so that
020hospice is also available through Medicare a uh and there are no um deductibles for any of this and there isn't so um then there's Medicare B Medicare B covers everything else covers all the other stuff that you think about covers doctors covers day treatments emergency rooms Labs diagnostic tests durable medical equipment V visits to the hospital after you've gotten out of the hospital so after your Medicare A has stopped if you're going back to the hospital for treatments as opposed to being treated at home um is in Medicare B there are co-pays um and they are fairly um significant ones and there I want to say there and and there is an an annual payment that you make uh typically for any service that you're getting that is covered by Medicare B Medicare will do
021this calculation of what the um value of that service is or the cost of that service is in your area and Medicare will then pay for 80% of that amount the rest of it is on you so Medicare B services do not come for free right but they but Medicare does cover a substantial amount of the bill and because it's Medicare no matter how much your doctor or other service provider wants to charge uh Medicare determines how much that doctor or other service provider can charge pays 80% of it and specifies as a condition of these doctors and other providers uh accepting these payments that um they can't bill you any more than that so-called balance billing is prohibited they can't bill you for the balance of that additional payment so the point is Medicare
022be and right and and as of uh now uh the med the mandated monthly premium for Medicare B is $174 and 80 at least it might be higher than that and it typically is can get much higher than that if you have a lot of extra income I know one of the uh and and by the way that extra income is based on your previous years's income so I've had had people call me because their um Medicare pre their their their part B uh deductible or payment went up to $300 from1 174 to this huge figure and then I'll talk to them and and they'll say oh well you know so what happened did your income go up oh no we just sold our house well if you sold your house that was income if
023that income therefore pushed your other income above the the the limits that are specified in Medicare for that one year for that that your income was really high Medicare is going to whack you so anyway that's how the traditional plans work and then there are the supplemental plans the plans that cover what Medicare doesn't so when you think about uh when I I was younger um I always thought it thought that there was just one plan and maybe there was I don't know it's called medx and that was the point of medx medx was meant to cover any of the deductibles or co-pays any of the other costs that were incurred after um the government paid their Medicare A or Medicare B payment uh now there are a number of these plans uh that are
024out there they vary by they they're priced differently they very you know certainly I think many people get basically the highest level plan because that highest level plan will cover all of the deductibles and therefore that highest level plan has the highest of the uh of the monthly premiums so in terms of dealing with your non-drug related Health Care um you need to figure out the there are all these calculations um that would kind of automatically happen if you're simply on standard Medicare A and B and haven't done anything else then there's Medicare d uh you may remember Medicare D was adopted seems like a long time ago now in the Bush Administration about 10 years ago uh and the point was that there were so many seniors that were having such financial problem dealing
025with drugs which was never covered by Medicare A or Medicare B so under Medicare Medicare D government's not throwing any money um um but you the the there are there are various plan providers who can be the same providers like Blue Cross and Harvard Pilgrim and other large providers that are providing U Medicare um supplemental plans who will also provide a plan uh that will pay for your drugs except that the plan won't pay for like all of your drugs the plan will pay for some of the drugs uh and it may or may not have a co-pay and it may or may not have there may or may not be deductibles the premium will be be fixed during the year um and some drugs may not be covered so the the challenge regarding Medicare
026D is that things are not fixed and you don't know what's going to be there from year to year and so what you really need to do uh is shop among the available Medicare D plans including by the way the plan that you're probably now on uh to make sure that that plan next year is still going to give you the benefits um that you were hoping that it's it was going to give you then finally there's Medicare c um which is used nationally a lot over 33% of all cases or Medicare C cases in Massachusetts uh much less so it's a they're private insurance plans they're offered by a number of the companies not on anaka and Martha's Vineyard where I do a lot of work but every place else where I do work
027uh and they offer off and they often offer some additional benefits that you wouldn't get under traditional Medicare Eye Care Hearing Care uh dent uh the cost of staying healthy often often I hear people refer to the the silver sneakers plan which is one of the Medicare C plans uh dealing with all of that so the good news about Medicare is that everyone qualifies for all plans you can change your Medicare D plan you can change your Medicare C plan right um that those changes occur once a year uh when there's this period during which you're supposed to kind of reexamine your plans that period is right now uh it started October 15th and it runs until December 7th the bad news is though you need to figure all this out yourself so the question
028is how do you figure this out well this presentation as you've been able to tell is not about legal advice right this is really kind of more general advice about dealing with this issue which every senior faces but from all the folks that I've talked to um they they'll tell me that they'll first of all figure out what's your strategy first of all what's your Medicare D plan you need to check what it is now check what your premium is and look at that same plan and see what it's going to be next year and then compare it to other plans then you got to figure out your Medicare supplemental coverage what used to be called medx which plan you're now you now have that plan you could get a new plan next year um
029the question is what's the best deal for you among all of the plans then you want to consider Medicare C because Medicare C covers all of the above Medicare C covers everything that a b and d cover and some and the extras so you want to compare then what those extras are and the pricing of all of those extras against traditional Medicare A B and D but finally my strong recommendation is that before you try to actually figure out all that out get yourself some help um three obvious places of getting the help are the shine counselors that are at the local senior centers um the mass College of Pharmacy and Health Sciences uh located in Wier that provides advice to folks and and these are all for free and and private sector advisers um
030there's a wonderful one uh Peter McKay who I do this slide and of course it's in an and everybody knows Peter M because Peter had worked for years and years uh at the hospital um um dealing with all of these issues of patients that were going home and what the available Services were Etc he finally retired um um so that he could just play a lot more golf but also so that he could do this he provides advice to folks every year um who are to help them try to figure out what their new plan is is typically he tells people I can say he's he tell he's given me these incredible stories of people who walked in thinking that everything was the same for them for next year and finding that they could actually
031save literally thousands of dollars the following year just by sitting down and examining what the new plans were what the available plans were um so what because and he told me what you need to look at um is you need to look at what your drugs are that you're taking you need to look at what the drug strength is right doesn't make any difference how many pills if you got 100 pills that have only got you know one milligram of something as opposed to one pill that's got 100 milligram you may want to just take one pill uh what's the dosage strength and how many doses per week or per month do you use and then you use that to figure out um based on these different plans what it would what these different plans
032would cost you then what he tells me that you need to do is you need to look in the mirror um because the nice thing about uh Medicare um is that you can really try to estimate you can look if look look forward and say you know maybe I was really healthy this year but do I have operations that I know are coming next year am I worried about potential real changes in my health or in my health care costs next year so look in the mirror and and you need to say to yourself so how much risks do I want to take and how much risk can I afford uh many people can't afford these maximum these maximum plans if you can then the it's a budget question do I want to use that
033money now for insurance versus keeping it in the bank um get some advice the best thing that I can tell you to do is talk to one of those shy counselors I'm just using um Carolyn McLoud as the example because in in all of the my experience over the last 13 years at Myra oconnell um uh working on these matters she's the greatest shine counselor I've ever met um but talk to the shine counselors in your community or in any Community since all senior centers are open to all seniors you know it's not just by Community figure all this stuff out hopefully with some kind of professional advice look at the Medicare C options if they're available for you um and then add up the bills add up everything and just figure out which one
034is better you know because you it this is a these are Classic Insurance questions the question is how much premium do you want to pay versus how much Insurance do you want to pay for once you're once you're done or you know see if your current plan needs changes see if the your plan itself has changed because the old plan may not be the right one for next year uh and then buy yourself dinner with all the money you just saved by figuring all that out so I hope you enjoyed this presentation I hope you take my advice which is don't go talk to your lawyer go talk to the shine counselor or private advisor right do the figure this out or do it yourself as a test do it yourself figure out the the
035amount of money you were going to spend when you did it yourself then go talk to one of the shine counselors see if you came up with the same number so I hope you enjoy this presentation and I'll look forward to seeing you on the on the uh the next and final installment of elder law 101 thank you very much