Understanding Medicare costs

Patrice King Brown: Whether you’re new to Medicare, exploring your options, or just want to keep up with the latest in Medicare news, we’ve got you covered.

Stacy Smith: No fluff, no jargon. Just real conversations to help you navigate Medicare with confidence. I’m Stacy Smith.

Patrice King Brown: And I’m Patrice King Brown. Welcome to “Medicare for the Record,” brought to you by UPMC for Life.

Hello and welcome to another edition of “Medicare for the Record.” We're glad you joined us today and we think you will be, too. We have with us today, Kendra White. Kendra is the Director of Community Engagement for Medicare at UPMC Health Plan, and she's going to walk us through some of the costs and what you can expect as a member of the Medicare Advantage Plan. Kendra, welcome.

Kendra White: Thank you.

Patrice King Brown: Thanks for coming today. Tell us about yourself.

Kendra White: Well, I've been in this role for over 20 years at UPMC Health Plan, and I think my background and experience is in public health and gerontology, which, you know, I was sort of raised by my grandfather so I have an affinity for older adults and it really fueled that passion for education and the importance of reaching out to folks to make sure they understand what's available to them, how to use these benefits, what to expect during the year. So it's been a lot of fun, I guess you could say, over the years.

Stacy Smith: Kendra, UPMC has several different Medicare Advantage plans and a lot of people take a look at the premium, the cost of that. It can range from zero to a little bit higher than that. Are there other costs involved, out-of-pocket costs that you might be facing?

Kendra White: Sure. You did mention the premium and that is what they pay every month to have their insurance. It's like paying for your insurance premium [on your] car, house, et cetera. But we do have copays that are associated with it, something else that members will look at when they're shopping plans. And that's basically if you're going to the doctor or the hospital or a specialist, that's a set amount that you would pay for that service. So it's almost like a point of service that you pay, that amount. Members would know what they are ahead of time. They are spelled out in all of the things that we offer them education-wise. So that would be for the service.

There's also a Part B premium. That is a monthly premium amount that is paid to original Medicare. Most folks will have it come out of their Social Security check, so they don't have to see it necessarily. And it does change from year to year.

Stacy Smith: And involved in all of these different plans, depending on what plan you choose, you might be looking at things like a deductible?

Kendra White: That's correct. A deductible is, we like to explain it, is a set amount that you pay before you would pay copays or other out-of-pocket costs. Not all plans have a deductible. There are some that do. It just depends on, you know, how…what your preference is. It's almost like car insurance. If you have an accident, you pay a deductible first. The rest is covered. Similar in your Medicare, is that, you know, that deductible is that set amount. So whether it's a $200 deductible or $2,000, you'd pay that amount first for certain services. Not all services are included in that deductible. It also is just another point to look through your plan documents when you're making a choice or decision.

Stacy Smith: So that's an out-of-pocket cost that you would be facing?

Kendra White: Yes, that is correct.

Stacy Smith: There is something else that you, you mentioned about car premiums. I don't think there's a such thing as a coinsurance on the car. There may be, but I'm not aware of it. So what is, how does coinsurance work?

Kendra White: Coinsurance is another term that we spend some time educating folks about because it does get a little tricky. So a coinsurance is a percentage that you pay for a service—and again, it's depending on your plan and what that service is. What we might find is someone on, like, a PPO—which is, gives you in-network and out of network coverage—if you go out of network, you would pay a deductible and a coinsurance for that service typically. Now, again, it also depends on the type of plan that you're on. You might never have to have a coinsurance, but typically it's a percentage of whatever the service is that you're having at that time.

Patrice King Brown: So what about a maximum out-of-pocket cost?

Kendra White: Maximum out-of-pocket cost is another good one to talk about. And, you know, those vary as well every year. But typically what we have is it's almost like an added protection that's in place for the beneficiary. So once their out-of-pocket costs for medical care reaches a certain amount—let's say it's $3,000, we'll just use that as an example—then after that, they would pay nothing for their medical care. That's their added protection on medical services. And don't be confused, the maximum out-of-pocket amount is not a deductible. In fact, any deductible that you might have on a plan would go towards that maximum out-of-pocket number.

Now, Part D is a little bit different. The drug costs are managed separately and a little bit differently when it comes to the out-of-pocket max.

Stacy Smith: But on the out-of-pocket max, that can vary with each plan, is that correct?

Kendra White: That is correct, yes. So you also want to take a look at that when you're looking at your plan choices for the next year. It can vary from plans, like for UPMC for Life, we have some that might be lower than others, but it's all spelled out in those documents and we try to educate folks about what that means.

Patrice King Brown: Yeah. Can we plan, so one can plan for next year on these costs? How does one do that?

Kendra White: That, I mean, we do spend a lot of time with our members. We have a series of in-person meetings that we like to do and we sit down with them and we say, you know, what are your anticipated costs? Obviously nobody anticipates certain health things—going to the hospital for surgery or emergency surgeries, et cetera. But if you know, you might need to have a hip replaced or a knee, you can plan for those kinds of things. You can look at your medications and plan, you know, okay, here's what's going to cost me this year. Let me look at what it's going to cost next year. Typically, medications don't change too much if you're on something for maintenance and you stay on that over a period of time. But it’s, you know, we have some members that will come with a list of everything and they're ready to discuss and talk it through. So at the end of the day, we just try to be advocates for these beneficiaries, whether they’re our members or not, because they can change plans every year.

Joining a Medicare Advantage plan can give you some stability because you're able to see what those costs are going to be at the beginning of the year. You'll be able to see what the copays, coinsurance, et cetera, are in those plan documents. And it helps us to have a little more ability to plan and budget or just be aware of what we might have to spend in the coming year.

Stacy Smith: You talked about staying with UPMC and the things that UPMC offers. The plans also offer some extra benefits. Do you have to pay for those or does that depend on the plan and what kind of benefits?

Kendra White: Well, that's a great question about extra benefits and services because we are very proud to be able to offer those types of things within our Medicare plans. Those are things such as hearing, dental, vision services, and then there's other things that would potentially be no further out-of-pocket costs like our fitness benefit. We have a travel concierge program, so if you do travel a lot, you can access some of those benefits. The Assist America program is one that's always been one of my favorites because if you do travel and something happens to you and you're out of the area, you can call them and they'll help you right away. If you need medical services, they'll make sure they get you to the nearest facility that can treat you. Now in an emergency, you can go to any facility anywhere, regardless if you call or not. But the travel program is great because we've heard wonderful stories over the years of members that had a lot of success with getting the help they need—whether it's emergency services and surgeries, prescription drug issues. We even had a story about someone was on a sailboat and her husband was having chest pains and they made it to the Canada border and they had a full medical team that was there waiting for them.

Stacy Smith: Being able to call, is that 24 hours a day?

Kendra White: The Assist America is 24 hours, seven days a week. You get a live person on the phone.

We also have the UPMC MyHealth 24/7 Nurse Line, and that is a place, or a phone number, that members can dial all hours of the day. So if it's two o'clock in the morning and you're not quite sure about the way you're feeling, you can call, you get a live person on the phone; they'll talk you through your symptoms. Obviously if it's an emergency, you go to the nearest hospital, you call 911, et cetera. But we do have that line that's available. Members can call questions about their medications, whatever that might be. You have someone that will answer the phone for you.

Stacy Smith: Are all of these benefits included in all of the different programs?

Kendra White: For the most part, yes. I mentioned the travel program, it's for our HMO members. And certain plans have certain things as far as hearing, dental, vision, it's all different. Again, when you're shopping and looking at your plans, you want to compare those types of benefits, what the out-of-pocket costs might be for certain things. It's in all of the plan documents and we're always here to help as well.

Patrice King Brown: Do you have any resources that are available for members if they have questions about their benefits?

Kendra White: Absolutely. My favorite program is our Health Care Concierge team. They are behind the scenes helping our members that call in every day. They can help them. You know, if you have a question about a bill or something that you received, you're not sure of, we always tell members, don't just pay it—call and we'll explain it to you if you don't understand it. These folks are trained and they're on the phones all the time. They can even connect them with resources that are in their communities if they're looking for certain things. So we always say, if you, if you, have a doubt, give them a call.

Patrice King Brown: Kendra, are there ways that members can save money on their plan?

Kendra White: There are ways that members can save money. If they use in-network providers, they would have the lowest cost sharing and copays, et cetera. For their prescription drugs, typically using a preferred pharmacy will help with the lowest cost share available. It's, again, important for them to look at their documents to see what's covered and where. And we're always here to help as well.

Stacy Smith: Kendra, the annual enrollment period begins in just a few days, October the 15th. So what should we be doing now?

Kendra White: By now, you should have received your Annual Notice of Change in your mailbox, sometimes referred to as ANOC. And in that document, it gives you an opportunity to see the changes that are going to happen in the plan that you're currently on. So it will spell out the highlights and give you that information. And with that information, you can certainly shop around with other plans to look for maybe a little bit less out-of-pocket cost. But in the end, we have lots of resources for our members and potential members where you can get the information on the plans for the upcoming year.

Stacy Smith: OK. But there's so many different aspects to this that you should take your time to do this.

Kendra White: There are a lot of plans, a lot of different plans, and we have lots of options for our members and potential members to get as much information from us as they can. We're committed to making sure they understand their benefits before they make that selection by December 7th.

Patrice King Brown: So it's basically, take your time. Take your time, so you're not overwhelmed by a last-minute deadline that you've self-created basically at that point…

Kendra White: That's correct. And we do, we offer—we have a telephone option. We have in-person options for education and making sure they understand the changes that are available or happening for them. And there are people that do it last minute. December 7th is one of our biggest days of enrollment. So we're there and we're ready.

Stacy Smith: Thanks so much for joining us today, Kendra. And thank you for joining us as well for today's episode of “Medicare for the Record.”

And before you go, we should tell you about three things that you should remember from this podcast. And that is, first of all, that your monthly Medicare Advantage premium is a cost that you're going to pay whether you use it or not, and that, make sure that your premium works for you and your budget.

Patrice King Brown: And you want to look at the care that you use and also the prescriptions that you fill so that you can estimate what your next year's costs might be.

Stacy Smith: Also, you can save money by getting care from in-network providers and also having your prescriptions filled by preferred pharmacies. So before we go, Kendra, one last question and that is, where can people get more information?

Kendra White: They can go to our website. It's www.upmchealthplan.com/medicare. We have a plan comparison tool that's right on the website they can utilize. It's actually an excellent tool, helps me with my parents when they're making their decisions. You can also find various parts on our website that are dedicated to going into more detail about some of the things that we've spoken about today as far as the benefits. And there's also a live chat function. If you're so inclined, you can, you know, live chat with someone right there on the website. So it's really evolved into a helpful and useful tool for Medicare beneficiaries during this time.

Stacy Smith: Kendra, thanks so much for joining us.

Kendra White: Absolutely, thank you.

Stacy Smith: And we hope that you join us again for the next edition of “Medicare for the Record.”

Thanks for tuning in to “Medicare for the Record,” brought to you by UPMC for Life. To learn more about your Medicare options, visit upmchealthplan.com/fortherecord.

This podcast is provided for general informational and educational purposes only. It is not medical care or advice. For questions regarding medical care, please consult with your health care provider. Views and opinions expressed by the participants are solely their own and do not necessarily reflect those of UPMC Health Plan, its subsidiaries, parents, or affiliates.

 

UPMC for Life has a contract with Medicare to provide HMO, HMO D-SNP, and PPO plans. The HMO D-SNP plans have a contract with the PA State Medical Assistance program. Enrollment in UPMC for Life depends on contract renewal. UPMC for Life is a product of and operated by UPMC Health Plan Inc., UPMC Health Network Inc., UPMC Health Benefits Inc., UPMC for You Inc., and UPMC Health Coverage Inc.

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