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Medicare, enrolling in Traditional or Advantage with Chris Eaton Apex Insurance

Apex Insurance Group – Health Insurance in Venice Florida (coveredbyapex.com) 941-221-9368

Erin Fountain
Hi everybody. This is Erin Fountain with Suncoast Social Security Advisors, and my guest spotlight today is Chris Eaton with Apex Insurance. Chris does a lot of things he does health plans for individuals and groups. It covers Medicare, both traditional and advantage. And I’ve asked him here today because I always get questions about Medicare, even though I handle Social Security planning. And when I get those questions, Chris is one of my favorite people to refer to. So, Chris, thanks for being here today. I appreciate it very much.
Chris Eaton
Of course. Thank you for having me. I’m excited to be here.
Erin Fountain
And you know so many questions that I get from Social Security, and I know you get kind of similar ones that’s where our universes kind of meld together. In between Social Security and Medicare, and often Chris, I hear women who say, you know, I didn’t work outside the house, I was raising the kids (You know, this is a very traditional setting for women who are coming into retirement now.) -and I’m not sure if I can qualify for Medicare. So, what would you say to someone with that question?
Chris Eaton
So, it’s a very good question and a very common thing actually, in order to qualify for Medicare, you typically have to have had worked and paid into Medicare and Social Security taxes out of your paycheck for at least forty quarters. They don’t have to be consecutive quarters, but just at least forty quarters in your lifetime. That equates to 10 years, but a lot of stay-at-home Moms or working Moms didn’t do that. They still get Medicare, and they get access to Medicare as long as their spouse qualifies. So just like Social Security, if their spouse is able to get Social Security income, so is that of the stay-at-home mom or the stay-at-home wife.
Erin Fountain
OK, now I know that for Social Security they can get a limit. As far as benefits go. Can you tell me how that works when it comes to Medicare for the wife who doesn’t have you know the full quarters of coverage. As a spouse – what do they do that they sign up and then what?
Chris Eaton
Luckily, that’s pretty easy because Medicare is you’re either in or you’re out. There’s really no in between. If you qualify for Medicare, you qualify for all of the benefits associated with it, so you can get parts ABC&D you have access to all of it as long as you qualify.
Erin Fountain
And what’s included with different ones? I mean, are they all the same?
Chris Eaton
Well, you have two main options you don’t typically want to stick with, just original Medicare. Some people make that decision, but most of the time we’re also looking at Medicare Advantage plans and Medicare supplement plans. I like to illustrate both to clients. There’s a lot of speculation out there about certain types of policies and people haven certain opinions about them, but I like to educate everybody and have them look at advantage plans, the pros and cons of each one, and then also look at Medicare supplement plan. And then again, the pros and cons of those as well. So, you don’t have just original Medicare, you also consider advantage and supplement plans.
Erin Fountain
OK. So then once they have a plan, there’s or there’s things that they get regardless of what plan they’re in? Because I know women have to go to the doctor like every year, there’s and everyone does, but they’ve got their usual annual physicals and things like that. Are there standard preventative considerations that are always when you get a Medicare traditional or advantage plan?
Chris Eaton
Yes, with all three. If you stick with just original Medicare or if you add a supplement or if you decide to replace original Medicare with an advantage plan, you get your annual physical which is you know, your Wellness check blood work associated with that as well as your yearly mammogram and gynecology visit then of course. Most of us don’t do it every year, but you also have the colonoscopy that is covered 100% as well.
Erin Fountain
Well, it’s really pretty amazing. You know, I met someone the other day and she just turned 65 and she said it was like Christmas. Everything is covered. But she was very glad to have Medicare coverage. But you know, when I was caring for my mom, she was on traditional Medicare. And I’m just curious, I’ve heard for different reasons for different circumstances. Would you ever switch between the two plans and how hard is that to do? Between the traditional Medicare and an Advantage – Going back and forth.
Chris Eaton
So, with a . . . and kind of to preface that a little bit, Medicare Advantage plans sometimes can be difficult to have because a doctor’s office might have to prove to the plan that something you need is truly medically necessary. So, I call them hoops. Your Medicare Advantage plan might make you jump through hoops in order to get something taken care of. If it’s more so on your doctor’s end that you have to do that rather than on your end, but let’s say you need an MRI on your knee and you’ve already had one taken care or had one image taken, you might, or the doctor might have to prove to your advantage plan that a second MRI is truly needed. They didn’t get the right picture, or the image was blurry, or something went wrong versus with Medicare supplement plans that are a little bit easier to have because they don’t from my experience at least they don’t have as many requirements and prior authorization as advantage plans. So, if somebody chose an advantage plan and said, hey, I’m having a hard time with this, I want to switch over to a Medicare supplement because I hear it, it should be easier. They might not be able to make that switch. If you are outside of six months of being enrolled in Medicare Part B then you do not have guaranteed acceptance. Typically, that means you would have to go through underwriting with that carrier, that carrier is going to ask you medical questions, ask you for a list of doctors that you’ve seen over the last 24 months, and they are going to determine whether you can get into that supplement or whether they’re not going to accept you.
Erin Fountain
And that is why we have a specialist like you to help navigate through those waters, because they sure can get bird caged. I know you join me for a quick minute today. Is there anything else that you want to share that you think would be pertinent? Although you’ve shared quite a bit and I appreciate it.  Any final comments or thoughts?
Chris Eaton
If you’re meeting somebody regarding Medicare, it’s very important to have a list of your medications with you, because the plan you pick may or may not cover those medications. But another plan might cover them at a cheaper rate or actually provide you with those plans or those medications for free. It’s also important to have the name of the pharmacy you go to as well. You don’t always have to have the address of the pharmacy, but if you go to CVS or Publix or Walgreens, that will help with quoting and finding the right plan as well as a list of your doctors to make sure that they are in network with the plan that you choose.
Erin Fountain
Wow, that is great advice. Well, listen, this is a quick minute that we’ve had to share today, but a lot in that time, the best way to contact you and I’ll also have your information displayed here with the podcast is 941-221-9368. And also, I notice on your website you have apexcalendar.com. So, if someone’s ready with questions they can schedule time to meet with you and talk to you then.
Chris Eaton
Yes, exactly. Thank you.
Erin Fountain
Alright. Well, Chris again, thanks so much. And for those of you listening, this is important stuff and there’s so much involved with it. Don’t miss the opportunity to talk with Chris, you can get a lot of information. Thanks Chris.
Chris Eaton
Thank you, Erin.