Decoding Health Insurance: Tips, Tricks, and Insights from an Insurance Broker

Welcome to the Get Healthy Tampa Bay Podcast with Dr. Kerry Reller! This week I am joined by Lorena Tomasini to discuss preventive services, choosing the right health plan, considerations for special populations, coverage for obesity medications, an overview of Medicare, and the importance of working with a broker.

Lorena Tomasini is a seasoned professional with over 12 years of experience. In the realm of life insurance, Lorena comprehends the profound impact it holds for individuals, families, and small business owners. Making pivotal decisions about financial protection is our forte.

Lorena aspires to impart our accumulated wisdom to prospects, referrals, and clients in a manner that is both enjoyable and enlightening. Pioneering a contemporary approach within the traditional industry, Lorena caters to a diverse clientele, spanning from millennials to baby boomers.

0:00 Welcome back! Guest Intro
0:54 Preventive Services 
4:45 Specific Conditions
9:10 Things Not Covered
12:00 Choosing the Right Plan
18:44 Reviewing Plans and Medications
19:50 Special Populations and Demographics
21:30 Obesity Medications Coverage
27:02 Overview of Medicare
30:41 Part B Medication Coverage
33:02 Medicare Advantage and Supplement Plans
35:05 Importance of Brokers
35:43 Closing Remarks, where can you find Lorena

Connect with Lorena Tomasini 
Website: https://www.malmins.com/
LinkedIn: https://www.linkedin.com/in/lorenatomasini/
Facebook: https://web.facebook.com/malmins22?_rdc=1&_rdr
Instagram: https://www.instagram.com/malmins22
Tiktok: https://www.tiktok.com/@loresini
Youtube: https://www.youtube.com/channel/UCOJArNxEnf0PG-h6rkYGHFA

Connect with Dr. Kerry Reller
My linktree: linktr.ee/kerryrellermd
Podcast website: https://gethealthytbpodcast.buzzsprout.com/
Facebook: https://www.facebook.com/ClearwaterFamily
Instagram: https://www.instagram.com/clearwaterfamilymedicine/
Clearwater Family Medicine and Allergy Website: https://sites.google.com/view/clearwaterallergy/home

Subscribe to the Get Healthy Tampa Bay Podcast on Apple podcasts, Spotify, Amazon music, iheartradio, Stitcher, Google Podcasts, Pandora.

Transcript

Kerry: 0:28

Hi everybody. Welcome back to the Get Healthy Tampa Bay podcast. Today we have a very unique guest, Lorena Tomasini. She is an insurance sales agent and she's going to tell us everything she knows of what to be looking out for and basically what to do. But can you tell us about how you got into this and a little bit about who you are?

Lorena: 0:48

Sure. So thank you so much for having me on. I've been in the insurance industry since 2006, back when I was studying finance here in Miami. And my mom's actually in the industry and she needed an appointment setter. So one summer I'm like, Oh, I could set appointments for you. Like that seems simple. And I always knew what my mom did, but it's not the same as like going in person. So I went with her to one of the appointments and I'm like, Oh, you just fill out paperwork and talk to people like I could do that, you know? So I got my license as well to do it part time while I was going to school. And then I just decided to continue as my career.

Kerry: 1:28

Awesome. And as I just learned before talking with you, you need a license to sell insurance. So who knew? And you're licensed in other states as well, not just Florida.

Lorena: 1:37

Yeah, so I'm licensed in multiple states because I also speak Spanish, so there's a lot of need for Spanish speaking professionals in other states.

Kerry: 1:46

absolutely. Okay. And our area too in Tampa, I think Spanish speaking population as well. Okay. so can you kind of overview, like how does health insurance work? And some people don't know.

Lorena: 1:58

sure. Sure. So, I mean when we're looking at health insurance for individuals and families, there's really a few factors that would determine your cost. It's going to be Ages, family size and income, and with that little information, we can actually give quotes on the different insurance companies that are available just as an overview that that's what it is. But, health insurance is really transferring the risk from yourself to the insurance company that if you do have a medical emergency you have your finances protected from something catastrophic, right? Because a lot of times people will tell me, oh, but I'm healthy and I just go to the doctor once a year and I'm like, that's great. Sure. If you want to pay out of pocket for that, you can, but it's what about all the other stuff, right? Like if you need to do an MRI or a CT scan or something, that's very costly and the majority of people do have jobs, right, but they, they don't even have, you know, what they say, a medical emergency of like$500. So, much less something catastrophic, like an accident or something to pay for those bills. And we're not even talking about something more serious, like a chronic illness, right, like heart disease or cancer or something major like that.

Kerry: 3:16

I know one of the number one reasons why people go bankrupt is for medical bills, right?

Lorena: 3:22

Yeah. Yeah. And even though there's been a lot of changes with the Affordable Care Act and helping people be able to afford insurance, it is still like the number one reason why people go bankrupt, because they might be underinsured or maybe the plan they bought just had like a really high deductible or something. Right. So it still is the number one reason for bankruptcy. I think it's a lot less, like, declaring bankruptcy for that. But yeah, it's still, it's still up there. Mm hmm.

Kerry: 3:51

Yeah. Tell us about the affordable Care actions. You already brought it up.

Lorena: 3:54

So, you know, that's what some people like to call Obamacare or the marketplace. It's all the same thing. It's really insurance for individuals and families that are not offered affordable insurance through their employer. And you'd be surprised that's a lot of people because they don't work for corporations or large employers. That are required to offer insurance, right? Like. You're less than 50 employees, you don't have to offer health insurance. So the Affordable Care Act is really, I look at it like in 2 ways. 1 part is the patient protection. It's really called patient protection and affordability care act. So the patient protection part of that is that insurance companies can no longer deny people for a pre existing condition. There's no cap on what insurance companies can spend. So, there used to be a limit of like a million dollars or two million dollars. And let's say the insurance company reached that amount on a cancer patient, let's say, because that's very costly. After that two million, then that person would be basically uninsured because They reach their cap. So part of the Affordability Care Act changed it where there's no cap on what insurance companies can spend, right? There's also minimum essential coverages that all the plans have to cover, like doctors, specialists, hospitalization, maternity prescription drugs, right? The difference between the companies is going to be where you can get this done, because they all have their list of doctors. And then the other part is the affordability part. So maybe before you could buy the insurance because you qualified because of your health, but it was very costly, because Insurance has always been costly. And so part of the affordability part is based on income and family size. A lot of people qualify for premium tax credits to help them pay for their health insurance. So like a family of 4 that makes, I don't know, 50, 000, for example, would definitely qualify for a tax credit to help them pay for their insurance.

Kerry: 6:03

So the tax credit this is a a post tax thing. It's not like for the employer, right? You're putting a pre tax dollars to pay for the plan, right? So this is all post tax money. So then they could get a tax credit.

Lorena: 6:16

right. But it's not done through an employer. It's done. Yeah, on the individual marketplace.

Kerry: 6:21

Right. So they can still get somewhat of benefit like if you're getting your insurance through an employer, you can get a pre tax.

Lorena: 6:28

Oh, no,

Kerry: 6:28

but like you're putting pre tax dollars into it, so instead of putting pre tax dollars in, you put post tax dollars into it, but then you're available for tax credit. Okay. Okay.

Lorena: 6:39

tax credit. That's the actual term. And so it's called advanced because it's an advanced tax credit of the taxes you're going to file next year. So for for 2024, what we're looking at is what people expect to make next year. So it's for the taxes. You're going to file in 2025 for 2024, which is why it's important to report changes throughout the year as they happen. If you make more money, you make less money, whatever it is. So you're not hit with that tax bill at the end of the year.

Kerry: 7:13

So a patient can't get insurance or a person can't get their insurance through an employer and they come to an insurance agent like you. How do you walk them through the whole process of getting insured?

Lorena: 7:23

Sure. So with me, I basically explain a little bit about what the Affordable Care Act, kind of like what I did at the beginning. So they have an idea. And then I'll ask them a few questions, are you looking just for you? Are you married? Do you claim dependence on your taxes? And then what is the expected income for the family, so if they're married, it would be both of their incomes. It was just them, just them. And then from there, we would do quotes and then see what the plans are that are available. You know, are they looking to actually use the insurance or not? Because that will help us determine what type of plan they're looking for and then

Kerry: 8:02

do you mean by use the insurance or not?

Lorena: 8:06

so. That's going to depend, like, people that are a little bit higher earners their premium might be higher because they still might qualify for a tax credit, but not that much. So their deductibles and their out of pockets are higher than people that earn less. So if you earn less, meaning like between 100 and 150 percent of the federal poverty level, you also qualify to have lower deductibles and lower out of pockets. So it's more affordable when they use the insurance, but if it's somebody that earns more they don't qualify to have lower deductibles and lower out of pockets. So we might look at a plan that has a higher deductible, but maybe has fixed copays for, no deductible and a higher out of pocket. So it all depends again, based on what the needs of the clients are

Kerry: 8:57

Right. You're saying. If maybe if they're suspecting that they're more healthy that they don't need to go in as much, then they might choose that other higher deductible or option that is less out of pocket. Right. Right.

Lorena: 9:12

that all goes back to income too, because if they're lower income, then I wouldn't suggest a high deductible plan. I would suggest, you know, the zero deductible 1500 out of pocket or whatever it is.

Kerry: 9:25

Okay. Okay. So are you mostly directing them toward the marketplace or Obamacare or Affordable Care Act plans in.

Lorena: 9:34

Yes, so there's a lot of confusion because you might see ads that talk about private plans and like, oh, you can get a private plan with a people type thing. I Think there's a market for everybody but that's not really insurance, like it doesn't meet the guidelines of the Affordable Care Act. So if somebody has high blood pressure, that's considered for those types of plans, a pre existing condition. And then they also put caps like we used to have on their plans. They also have like limitations, like if you get injured in your job, it's not going to pay. So I don't see really a need for those plans when there's so many protections that the Affordable Care Act provides. When all you're really looking to do is save a few dollars on your premium, it might come back to bite you at the end, we hear stories all the time of people that bought something that they thought was insurance, but when they went to go use it, It didn't cover them. They were stuck with all the bills, right? And it's because people are unfortunately misleading out there with plans that look like insurance, but are not insurance, so I only specialize on plans on the marketplace or the Affordable Care Act or Obamacare, whatever people want to call it. Because they provide so much protections for the consumer, but also like two years ago, they did the American Rescue Plan Act, which is when a lot of people got, the checks that were pending for the pandemic, but the American Rescue Plan Act also made it that your health insurance had to be less than 8. 5 percent of your income. So, when we look at people that are like 50 and up, they still qualify for those subsidies when before they wouldn't, if they made like a hundred thousand, let's say, they still qualified for like 50 percent of their insurance to be covered. So, yeah, it doesn't really make sense. You get a quote first and then make an informed decision is what I always say, you know, then just going by what my friend said or my coworker or whatever. Okay.

Kerry: 11:39

So I know you're probably not specializing in it, but can you tell the difference between a Medicare plan and a Medicare Advantage plan?

Lorena: 11:48

Yes, but there's a lot of regulations as far as talking about Medicare, so we won't go into those details about that. But there are differences, like, just as an overview Medicare alone or original Medicare covers 80 percent and the person 20 percent with no cap. So, then to avoid paying that 20%, they could get either a Medicare Advantage plan or a Medicare supplement plan. And there are differences between those 2 as well.

Kerry: 12:17

Yeah. I think our, I guess our patient population has a lot of Medicare questions as well.

Lorena: 12:22

Okay, yeah, that is again, because of compliance, we can't just talk about plans or anything like that. But certainly, yeah, if anybody wants a quote or something, the deadline for that is December 7th for the annual enrollment period.

Kerry: 12:39

right, yeah, I was gonna ask, I know it's open enrollment, but is that only for Medicare or is that for all

Lorena: 12:45

For both, so it's for the Affordable Care Act, it's until December 15th for January 1st, and then they also have until January 15th for February 1st, and then, yeah, Medicare is December 7th, and then there's another enrollment period from January 1st through March 31st but that's only for people that have Medicare Advantage plans.

Kerry: 13:06

Okay. Okay, so obviously, the point of health insurance is to protect your financial assets and to get the care that you need. How do you make sure, the patient's doctor is on the plan that you're suggesting so they don't have to change or anything

Lorena: 13:22

That's a great question and it, it comes up a lot, especially during renewals. So some people will say, oh, just go in the marketplace and search through the doctor there. That's not an accurate search. Like they're supposed to get it from the websites and all that, but I don't trust that. So I go directly into each carrier and there's plenty of carriers, to look through. So I go straight to the directories of the companies to look for their doctors right now. It could be that throughout the year they change doctors going in and out of the plans as they want sometimes. So today they might take it, but maybe in March, they're not taking it. Those are things that are outside of our control but yeah, it is important to review your doctors and medications yearly because that does change right?

Kerry: 14:12

Absolutely.

Lorena: 14:14

And that's the best way. It's not let me call the doctor's office because they might tell you. Yeah, we take that plan, but that plan that they take is for group insurance or they take it for Medicare or, you know, it's not necessarily what you're looking for.

Kerry: 14:30

Yes, we get a lot of confusion and sometimes are unaware of what plans that we actually take in our office and I mean, they put us on new ones all the time and we don't even know about it. So it is a little difficult. And if you go directly to the carrier. Or the insurer, they should really know that. And you know, and then there's another hoop, if it's an HMO, to make sure that, that your provider's name matches, you know,

Lorena: 14:57

Yeah, yeah, because we get that a lot. Like, they'll tell me, oh, I see this doctor, but the doctor doesn't come up and it's because they're using another doctor's name in the practice, let's say, as the one that comes up on the list. So, yeah, I always tell people if I don't see it on the list, I'm going to tell you it's not covered. They might tell you something else and okay, but, you know, it's, it's very important to make sure they show up on the directories.

Kerry: 15:24

So what do these plans cover, like as a general overview of these health insurances? What kind of things do they cover?

Lorena: 15:31

Yeah, so what we're talking about plans on the marketplace to clarify that it's not Medicare, right plans on the marketplace. You know, they cover everything that group insurance covers. And in fact, many times it's the same insurance companies. That you see through an employer, just maybe the list of doctors might be different, right? Or even the hospitals, but by law, they all have to cover certain things, doctors, hospitals, surgery, maternity, because before maternity wasn't even included in most plans. You need to pay extra to have it covered so that's also a big change maternity, prescriptions, mental health is included as well from day one, which is, I've been getting a lot of people asking me about mental health, like, oh, I have anxiety, I have depression. Is that stuff covered? And it is. What else do they cover? You know, they cover, The same things as a group insurance would cover because they have to so

Kerry: 16:31

well visits and things

Lorena: 16:33

the wellness visits. Yeah. So, like, by law for women like mammograms, the pap smear that that type of preventive services is covered as well at no cost, regardless of which plan you have and for men, like the prostate exams are covered as well. Depression screenings are covered for everybody. So, I mean, yeah, there's a lot of things that are covered at no cost that people don't realize.

Kerry: 17:00

Are there any things that aren't covered?

Lorena: 17:03

Well, you know, I had somebody ask me the other day their plan covered alopecia, and I tried my best. I just smiled because, you know, things like that that are cosmetic are not going to be covered unless it's medically necessary. Like, I always joke with people, you might want a nose job, but unless you run through like a window is not going to be covered by your insurance, so, yeah, I think things that are medically necessary, a surgery, you know whatever it is that people need,

Kerry: 17:30

Okay. So how do they choose the right plan for them?

Lorena: 17:35

that's a great question. That's going to be up to us as, as agents to do a thorough needs analysis and during this time of the year, while our appointments might be, 20 minutes or so, because it's a lot of people that we need to help and so many enrollments going on at the same time. I've been doing this 17 years, so it might be less time for me than maybe other agents, right? But making sure that they're asking you questions about Are you using the insurance? How did it go with the insurance? What concerns do you have? What did you like about the plan? That type of stuff. And then asking them, Hey, has your doctor's changed? Have you had change in your medications if you take medications, right? And then how do they know they're choosing the right plan? I give all my clients two to three options so they make an informed decision based on the co pays and based on if they want a plan that maybe doesn't require a referral. We can look at that. Or if they want an HMO where they do need referrals, then we look at both options so they can decide.

Kerry: 18:44

Do you have them one we already talked about this, but making sure their doctors on it, but to making sure their medications are on it?

Lorena: 18:51

Yeah, so that that's really important. Like, we, we get a lot of consumers with diabetes, for example, and so maybe 1 plan takes one type of you know, the machine or something, but the other plan does not so it's making its details like that That will make a daily difference for a lot of consumers, some plans for like Preferred brand drugs cost more than other plans. So, you know, it's important I spend at least one day At the beginning of open enrollment, looking at all the plans, looking at all the differences. And so that way I have an idea of what plan might be good for this consumer and which one might be better for this other type of consumer, because no two people are alike. So it's important that, they're making right decisions for them.

Kerry: 19:40

Absolutely. Yeah. Are there any special populations or demographics that people should pay attention to specific plan or anything?

Lorena: 19:50

I mean, there are some companies out there that have specific plans for diabetes. And I'm talking about on the marketplace, not Medicare, which they do as well, but on the marketplace, there are some plans that do cover for diabetes, at a lower rates than other insurance companies. And I also saw one for like heart conditions. So maybe that's for like, high blood pressure or something, but usually those are generic medications that are zero across the board, regardless of the company, but it is important to double check that you can't just assume that because this 1 is a generic is going to be 0 throughout all the companies.

Kerry: 20:31

Yeah. I've definitely had some patients who are on basic generic blood pressure medicines and then all of a sudden they switch and they're still basic generic blood pressure medicines, but they don't cover them. That's very surprising.

Lorena: 20:43

I've had my own clients sometimes switch through another agent. Like, Oh, my cousin got licensed. Okay, great. And then they'll come back to me the next year with like all these complaints that, you know, they never asked me about my doctors. They never asked me about my medications. And so it depends too, like for Medicare, as an example, that does take a lot of time because we have to do by compliance, we have to make sure that we're looking at their doctors, we're looking at their medications, there's a lot of things, checklist let's say that we have to go through before we even recommend 1 or 2 plans for Medicare.

Kerry: 21:21

And well, my big question, which I think I already know the answer, but is obesity medicine covered or anti obesity medications covered?

Lorena: 21:30

That's a great question. I've been getting that one too from consumers. Right now, a lot of carriers are probably denying that because it needs to be medically necessary and my understanding is they're using medicine for diabetes, to cover, I could be wrong.

Kerry: 21:46

it depends. There are definitely obesity medicines that are approved for obesity only that may be the same medication as diabetes, but a different brand name. So for instance, Wegovy is FDA approved for obesity, but the sister of it, Ozempic, which is same drug is FDA approved for diabetes and Mounjaro is FDA approved for diabetes. And now it's zep bound, it's terzapatide, same drug, FDA approved for obesity, and that just got approved recently. So we're getting in more and more of these drugs. We already had Contrave, Qsymia, Phentermine, all these medicines were obesity medicine, but they're not typically covered

Lorena: 22:24

I think that's going to be a long process before the insurance carriers catch up on that because for now they're saying, you know, oh, that's just cosmetic or

Kerry: 22:34

Exactly. They do not define obesity as a disease, which is the problem. And this is why they won't

Lorena: 22:39

cover it. yeah, they're like, try, you know, eat better or something. I guess that's what they're saying, before they start approving these medications. I mean, I think eventually they will because if there is a big need and they don't have to, but it's like, we hope they will

Kerry: 22:57

we hope they will. I think it needs to come from up higher. Right. And I think patients need to advocate for themselves. Granted, we're not talking about employee plans here, but for the marketplace, you're talking about going to representatives and things like that. Whereas for the employers, you can go to your employer to advocate for yourself, right? To the HR company.

Lorena: 23:17

But, it's still the same insurance companies, right? Whether it's through your employer or through the individual marketplace.

Kerry: 23:24

right. But the employer has the authority to choose to include that on their plan, whereas the government offering these insurances is not on board yet. The

Lorena: 23:32

Right. I mean, you know, what, what somebody could do is maybe get so on the marketplace, you can get a plan with the health savings account.

Kerry: 23:40

Yeah

Lorena: 23:40

and then if you put money into the health savings account, you could use it for that instead of paying for it out of pocket. Right?

Kerry: 23:47

but it will probably deplete that if you're on these newer medicines in about one, one month or less. Yeah.

Lorena: 23:54

Yeah. Yeah. Probably. Probably.

Kerry: 23:56

So I think for marketplace, definitely not there yet. They're not going to have any obesity medication coverage.

Lorena: 24:03

but, you know, if,

Kerry: 24:04

to tell us the names of the companies that are examples of marketplace insurance or. We don't have to do that. That's

Lorena: 24:12

no, but, you know, they're, they're all in there. If you go to like healthcare. gov,

Kerry: 24:16

Okay. Yeah. Healthcare. That's better. Yes. The source is healthcare. gov.

Lorena: 24:20

yeah.

Kerry: 24:21

Okay. Okay. What else do you think that listeners need to know about health insurance and what you

Lorena: 24:26

do I think it's important that people actually review their plans because, for example, I just got off a phone call with somebody who was like, Oh, why do I even need to review my plan because nothing has changed in my household. My income's the same. I live in the same address. I didn't get a divorce. Great. But the plans do change. And so maybe that same plan that you have this year, next year, maybe they increase the rate. Even though you still maybe have a tax credit, let's say and maybe now they're offering a different plan, the same company, but a different plan that has the same price of what you're paying now, for example, or a lower out of pocket or whatever. So, it is important to review your plan to take that 10, 15 minutes with your agent to review and make sure that you're updating the application for next year, making sure that plan is still a good fit for you. And as I mentioned, the deadline is December 15th so we're like, right now, we're a month away. Exactly. So, it's better to do it sooner than later, because the systems do crash as we get closer to that date, you know, you don't want to be stuck with the same plan or something, or not being able to change your plan until February, and then the other important thing is that sometimes people think that, oh, I can only apply for insurance during this time of the year. And that's not true. Like, let's say somebody's joining the quitting movement and quitting their job and now they're losing that health insurance. That person has a special enrollment to apply within 60 days for coverage on the marketplace, right? And the same, a lot of people moving to Florida, all those people moving are probably losing insurance. Or they need to change their plan.

Kerry: 26:13

Yeah, absolutely. Okay. Well, this is very informational. I'm happy to learn a lot because clearly this is not my expertise. I only know being on the physician side of the insurance and insurance companies are not our fan, but,

Lorena: 26:27

I know. I've heard

Kerry: 26:28

we're not big fans of them either. But you know, we, this is how our healthcare system works currently. So we do what we got to do and try to just help the patients. Yeah, so I would have more questions about Medicare stuff, but I didn't know you're not legally allowed to discuss it.

Lorena: 26:44

I mean, we can we can talk about general topics. If you have questions, ask them and then I'll let you know. Yes, we can answer that or not.

Kerry: 26:52

well, I just wanted to describe the difference between Medicare Advantage and straight Medicare and like supplement. Like, what is the difference between that?

Lorena: 27:02

Okay. So, yeah, I mean, that's like Medicare 101, which is fine, original Medicare is your part A and your part B. So, your part A is hospitalization and part B is medical services, right? And so, when you get that card, that covers 80 percent of your costs and you 20 percent with no cap. So, the hospital bill is 100, 000. Well, you're going to pay 20, 000, right? So, how do you help adjust for that 20%. So, one option is the Medicare Advantage Plans, which are the ones that you see all the ads on TV for. And so, Medicare Advantage Plans cover your Part A and your Part B. So, what doctors and what hospitals you can go to, basically. And then, a lot of them also include your Part D. So, your Part D is prescription medications. So, Medicare Advantage is also known as Part C because, you know, let's confuse people. So Part C is Medicare Advantage plans that cover your Part A, your Part B, and your Part D, which is why it's called MAPD. The PD is Part D.

Kerry: 28:13

okay.

Lorena: 28:13

Okay, and so you know, that works a lot like your insurance through an employer. These are your copays for everything. Some of them do include additional things like dental, vision and hearing, transportation. There's a lot of things that they include. And so that's one way of getting it. You're tied to whatever their list of doctors and hospitals are, okay? And so the Medicare, and usually you have no premium for those types of plans. You just continue paying your Part B premium, right? And then Medicare supplements work different. They also cover your Part A and B. but depending on the plan, because there's different plans for the Medicare supplement, some say, okay, with this plan, you just pay your deductible. And then that's it. You don't have to pay anything else for the rest of the year. People like supplement plans because they offer flexibility. You can basically go to any doctor or hospital that takes Medicare. Right? You don't have to worry about a referral anD so a lot of people like that option. If you get a supplement plan, you also need to get your prescription drug plan to make sure that you don't pay a penalty for not having that. So, that's really important to do that. So, with the supplement plan, You would be paying your Part B premiums, your supplement plan premium, because that does have a premium, right, and then your Part D premium. Usually they don't include dental vision. They might have like a discount. So some people also need to get a dental vision hearing plan, right? So I look at supplement plans like for people that want that flexibility. That they have the budget to afford all those premiums in retirement. Right. But it both are good options and both have their market so it just depends what people are looking to do.

Kerry: 30:07

Yeah, that's a very helpful breakdown. I think a lot of people don't understand really what they're signing up for when they get certain different things. So that's helpful. Just to draw out like a lot of questions I get are certain medications or immunizations that so part B covers, you know, the most common immunizations, I think, and then the newer ones are not quite on part B yet, but being covered under it. For a what is the word? I don't know, a temporary basis, perhaps like for RSV vaccine

Lorena: 30:40

Yeah. So.

Kerry: 30:41

like the pneumonia vaccine, the flu vaccine are covered. Oh, shingles is the other one. I think it's only like a temporary basis because people were getting upset that, you know, they're recommending that, but then they still have to pay for it. So this, in this recent year, they decided to cover that in some way so It is covered if you have Medicare.

Lorena: 31:00

So, I mean, yeah, it is important to differentiate that. So, like anything administered at a doctor's office would be under Part B, right? Chemotherapy, for example, that's administered at a doctor's office. Shots like that would fall under Part B. Now, I have seen some medications that say Part B or Part D. So that I don't know how they determine,

Kerry: 31:26

we have,

Lorena: 31:27

where, where it's going to fall, but I have seen that with a handful of people,

Kerry: 31:33

I'll set an example. So for asthma, we give let's just pick one of the asthma injectable drugs and it can be given at home or it can be given in the office. So I think it depends which one the patient decides on. So if it's obviously given in the office, it's going to be part B. Otherwise it's going to go towards, part D because it does have a, there's a couple of them have self administrative methods and that would go to part D and what people You Don't know or don't like about these things is that if they get these expensive injectable drugs, including the weight loss ones or diabetes ones that are injectable, they're usually more expensive. And if you're giving them to yourselves as part D and you can hit that donut hole a lot faster.

Lorena: 32:14

True, true. Instead of having to do the part B, that depending on your plan, you might have to meet your out of pocket.

Kerry: 32:21

Yeah. Yeah.

Lorena: 32:22

I mean, yeah, there's a lot of little things like that, that people don't realize are really important. It's not just do I get all these extra stuff with my plan? No, it's is this really the plan for you? And unfortunately a lot of the ads we see on TV are really marketed Towards the dual eligible population as we call them like people that have both Medicare and Medicaid Which is fine. It just causes a lot of confusion for those that are not on Medicaid, thinking, Oh, how come my plan doesn't give me all these benefits? It's because you're not eligible for that.

Kerry: 32:57

Okay. Are most of the advantage or all of them HMOs?

Lorena: 33:02

for the most part, but there are some that are PPOs as well, which is An interesting one because some people would rather get the PPO plan instead of the Medicare supplement plan because you don't have a premium on that plan and you can still go across to other states if you needed to, you just don't have that flexibility of going anywhere. Medicare is accepted. Basically, like, you can still go out of network. You'll just pay more.

Kerry: 33:28

Yeah, I think the most important thing is, like you said, they need to really read what they're getting into and understand it because it's hard on our end when they come in and they have no idea how their insurance works, like whether they have a deductible, whether they have a copay. Whether I have to bill for, you know, the well visit doesn't have a copay, but the regular visit does, if I refill in that, then you're going to bill, you know, like they don't quite understand that. They also don't understand, at least for Medicare part that, there's a intro to medicare visit initial medicare wellness visit. Does it include an exam? Not really. It's very confusing.

Lorena: 34:04

And I mean, these are things we do go over with our clients, you know, but it is overwhelming sometimes, which is why it's important. All of mine get a copy of like their summary of benefits, so they can look through that to make sure, okay, what is my co pay for this, right? Before walking into a doctor's office, at least having an idea. But there is that other side of billing for you guys, right? Like, how are you billing it? Which would be different, maybe, than what they see on the paper.

Kerry: 34:33

Right. Well, any last words on anything that you think that people need to know.

Lorena: 34:39

No, I think really important to work with a broker, so like a broker is like somebody like myself that represents different insurance companies to find solutions for my client. I don't just work for 1 company, Or really just asking questions until you feel comfortable that, okay, this is what I want to go with. So you can make an informed decision, not just or what you hear out there, what your friends say, or, you know, what they say on the TV. So.

Kerry: 35:05

Right. Right. TV definitely can be false. And leads you in the wrong direction. But anyway so where can people find you if they want to work with you?

Lorena: 35:15

sure. So the best way is to, to send me a text 786 236 1792 or not online. They can find us all of our social medias at M A L M I N S 22.

Kerry: 35:30

Awesome. Well, thank you so much, Lorena, for coming on the podcast. We have, you know, I learned a lot. Like I said, I would, so it was a delight having you. Thank you so much.

Lorena: 35:40

Yeah. Well, thank you so much, Kerry. It was a pleasure.

Kerry: 35:43

Okay. All right, everybody tune in next week for next week's episode.