EPISODE 18- Medicare in Oregon

Episode Description
In this episode of the Team Senior Podcast, host Jamie Callahan sits down with Medicare expert Debbie Hodgson to demystify one of the most important—and often confusing—topics for older adults: Medicare.

Debbie has been helping people navigate Medicare for over a decade, representing multiple insurance organizations to ensure her clients get unbiased guidance tailored to their unique needs. Together, Jamie and Debbie cover:

• The differences between Original Medicare, Medicare Advantage, and Medigap
• What’s covered (and what isn’t) under Medicare
• Common mistakes and misconceptions people make when enrolling
• How enrollment periods really work—and what happens if you miss them
• Assistance programs like SHIBA and how they can help
• Why reviewing your plan each year is essential

Whether you’re nearing retirement, already on Medicare, or supporting a loved one, this episode is packed with practical insights to help you make informed decisions.

Resources & Contact
For questions or guidance, you can reach Team Senior at (541) 295-8230 or connect directly with Debbie Hodgson.

Transcript

Team Senior Podcast: Medicare Explained with Debbie Hodgson

Podcast Introduction

Hi, this is Jamie Callahan with the Team Senior Podcast. Our goal is to simplify aging. Society grooms us to plan for retirement, but what about life beyond retirement, where the rubber meets the road? Perhaps you've had a stroke, or you've been diagnosed with cancer, or maybe you're forgetting things and now you have dementia. That's our area of expertise, and we are here to share our insight.

And now, the Team Senior Podcast.

Interview Begins

Jamie: Hi, this is Jamie Callahan, and we have a very special guest in the studio today. We defer to Debbie for all kinds of things regarding Medicare and Social Security. So Debbie, can you start by introducing yourself and sharing a little bit about what you do and who you are?

Debbie: Sure. Hi Jamie, thank you for having me here. I've been working or helping people with Medicare for about 12 years now. I started with my father-in-law, who was in his nineties. He wanted to make some changes. I wasn't working with Medicare yet, so I helped him. I researched a plan for him and got him changed to that plan. From that point forward, I decided this is something I want to do. I've been selling or offering insurance products for about 15 years before that, and now I pretty much totally assist people with Medicare and help, like you said, with Social Security.

Jamie: I love it. So something that's important to note quickly is that as an organization, Team Senior, we have over the years worked with lots of different Medicare reps. We've also worked with SHIBA, which is essentially the helpline which protects people from being oversold Medicare that they don't need, and a variety of other things.

The reason why we forged a relationship with Debbie Hodgson, who's here today, is because she is very unique in that she doesn't just offer one kind of Medicare. She represents somewhere between eight and 12 different organizations. So when you're meeting with her, she's not trying to sell you a specific kind of insurance. She's really not trying to sell you anything. She is gifted in sharing everything that is available to you and really helping you to dissect what's best case scenario in your life.

An example of that would be: I know, for example, that if you have certain kinds of Medicare—let's just take UnitedHealthcare for example—you cannot use Riverside Home Health. Or if you have other types of Medicare plans or supplemental insurance companies, you can't go to Providence Hospital. So we're gonna talk through some of those things today, but Debbie truly is the expert.

Every single time I get a call regarding anything in the insurance world—sometimes that's just as simple as, "Hey, I've been discharged from the hospital and they prescribed this new medication and it's $700 a month"—the first person I call is Debbie. How do we get around that? Do you have a new insurance plan? Do they write the order differently? What are our options here? And she can always answer those questions for me.

Medicare Basics

Jamie: So Debbie, I'm curious—we know what inspired you to work in Medicare. It sounds like it was your father-in-law, correct?

Debbie: Mm-hmm.

Jamie: Okay. So for those that are new to Medicare, can you explain the difference between Original Medicare, Medicare Advantage, and Medigap?

Debbie: Sure. So Original Medicare is what we work for and pay taxes for during our working career. We pay into Social Security to get insurance benefits when we turn 65. So Original Medicare is Part A and Part B. Part A covers hospital visits and such, and then Part B is for doctor visits, surgeries, and prescriptions that are administered at the doctor's office.

Part C and D are Medicare Advantage Plans. The Advantage plans roll Part A and B together. They coordinate your bills with Medicare, so all you have to do is show an insurance card and your bills are processed through the Advantage Plan Company.

Medigap insurance—well, let me back up just a little bit. Original Medicare is an 80/20 plan, which means they pay 80% of the Medicare allowable costs and you pay 20% out of your own pocket with Original Medicare. There's no cap on the max out-of-pocket, and there are deductibles with Part A and Part B. It does not include prescriptions, so if you don't have a prescription drug plan, then you're paying out of pocket for those.

Original Medicare is Part A and Part B. Medicare Advantage is your Part C and usually Part D. And then Medigap plans are the other alphabets—the Fs and the Gs and so forth. So that's the basic overview.

What's Covered and What's Not

Jamie: Got it. So can you give us an example of something that is covered under Medicare and, equally as important, what's not covered under Medicare?

Debbie: Medicare typically covers medically necessary services. Your preventative services are covered 100% based on your age. There are different preventative benefits. And then what's not covered is routine dental or vision—routine vision. So that's why you need to have other coverage to go with it.

Jamie: So there are coverage plans that cover dental and vision. What are those?

Debbie: Those are the Medicare Advantage plans.

Jamie: Okay, okay. So there's definitely value in having a Medicare Advantage plan. What are other forms of supplemental insurance? Are there any that we're not talking about just yet?

Debbie: To go along with Medicare, you have the Advantage plans or Medigap.

Jamie: Got it. Those two. Okay.

Enrollment Periods

Jamie: So when somebody is at a point where they need to apply for Medicare, we know that the timeline is typically end of year, every year, where you can get it or change it or all of those things, right?

Debbie: Well, when you are turning 65, that's your Initial Enrollment Period: three months before your birthday month, the month of your birthday, and three months after your birthday. That's basically your open window.

Jamie: So that's the first-time applicant?

Debbie: Yeah. If somebody is going on disability, once they are on Social Security Disability Income, most of those folks after a 24-month period qualify for Medicare. It doesn't matter what their age is.

Jamie: Really? Okay, I didn't realize that. So if you're 45 years old and you've gone on disability through Social Security, in 24 months from that time, you can apply for Medicare, no matter how old you are?

Debbie: Correct.

Jamie: Very interesting. I didn't know that—I learned something new today.

Assistance Programs

Jamie: So let's talk about assistance programs. I know, as I've already said, when I have anyone that calls me regarding questions for Medicare, I defer everything to you. There are other state programs though, right? So what is SHIBA? What do they do and how do they differ from what you do?

Debbie: SHIBA is a counseling division of Social Security or Department of Human Services (DHS), and they guide individuals. Medicare requires that we do some due diligence with the individual—find out who their providers or primary care provider is (if they have one), the specialists, medications, because it's really important to know that before you share the different plan options.

The SHIBA individuals are trained. They're not licensed agents. They don't get paid for what they do—they get paid by the government for their time. Brokers or agents cannot charge for counseling to help individuals look at the different plans. That's what SHIBA does.

Jamie: I think it's important to note that SHIBA—they are kind of an impartial third party, right? They're not getting any form of commission or kickback or anything like that to share information about the different Medicare plans. And as Debbie was stating, it's so important for you to note that it's your personal set of circumstances that really determine which insurance is best for you, because they're all different kinds of companies—Atrio, UnitedHealthcare, you could probably name 10 more. Just because what your neighbor has might be fabulous for them because of whatever their diagnoses are, the hospital preferences might not be the right plan for you. So important for you to come to the table with all of that information when you're looking at considering different kinds of Medicare.

Debbie, I'm curious to know: when someone comes to you, does it cost them to get any kind of guidance from you?

Debbie: It doesn't cost at all. I get paid by the insurance companies, and I get paid the same thing no matter which Advantage plan, for instance, they select. So that's why it would be unethical to lead somebody to a specific plan. I show them all the options each plan has for them.

Ethical Considerations and Common Scams

Jamie: And I love that. That's one of the things that really drew me to working with Debbie in the beginning—she is not trying to... she doesn't represent one insurance company and she's not trying to sell any one thing.

Something that you just mentioned is the ethical piece of what Medicare representatives do. So I just want to touch on something that was kind of circulating, and I don't know what company was doing this or what broker was doing this, but there was recently this kind of telephone tree program where people were getting inundated with calls or the opportunity to call. I think there were even advertisements on television about food cards. You could call them and you could get free money to buy food. Well, it was really just bait for an insurance company.

That's something that has to be noted here: the insurance brokers like Debbie, they cannot advertise. They can't do a whole wide variety of things right up until, I think, like a month or something before you can enroll for Medicare. But you certainly can't be running television commercials saying, "Hey, call me for Medicare questions."

Debbie: You can, if they're general enough. As far as the food cards go, individuals primarily need to be dual eligible, which means they're on Medicare and Medicaid both. I get calls all the time—people say, "Hey, I saw this ad for free food." If you don't qualify for Medicaid or haven't applied for Medicaid, then that's pretty much off the table. But once you make that phone call, a lot of times those call centers will switch a person to a different plan, and I've had people switch plans that weren't even available in our area. So you have to be really careful about those 800 numbers.

Jamie: Yeah, I mean, I get those calls too, where somebody will phone me and explain that they got this telephone call or they talked to somebody and they're trying to convince them to change insurance plans, and what do I think? And what I think is: you should call Debbie. That's what I always say.

Debbie: You really should talk to a local person that you can see face-to-face, either at their office or—some agents do home visits too.

Common Mistakes and Misconceptions

Jamie: I love it. So what are some of the biggest mistakes that people make when enrolling for Medicare?

Debbie: Not really looking at all the options. Like we said earlier, make sure that the plan that you're enrolling in has the best out-of-pocket costs on your prescriptions, your doctors are in network. There are tools out there—Medicare offers tools at Medicare.gov. There's a list of questions that are common that you should ask. Do your due diligence.

Jamie: Do your due diligence. That's probably the biggest takeaway here. What are some common misconceptions that folks have about applying for Medicare?

Debbie: That Original Medicare Part A and Part B covers everything.

Jamie: So that's really 80/20, right?

Debbie: Mm-hmm.

Jamie: Got it. So what does somebody do if they can't afford premiums or copays with that 80/20?

Debbie: If they are low income, a lot of times I recommend that people go up to the DHS office here in Grants Pass—there's one at the north end of town. See what extra benefits they might qualify for through the state or federal assistance programs.

Key Advice and Closing Information

Jamie: Okay. Yeah, I mean that's really great advice. So we have to close because we've pretty much run out of time here, but I would close with asking you to share with everyone: what is one piece of advice you wish that every Oregonian knew before signing up for Medicare?

Debbie: Making sure that they understand the enrollment period so they don't enroll late. If they are on a group plan, make sure they have somebody compare their group plan to their Medicare options, because even if they have a great group plan, they may have better benefits through Medicare.

Jamie: Got it. So let's talk about that enrollment period quickly. What is the month of every year where it's open enrollment?

Debbie: The Annual Enrollment Period is October 15th through December 7th. And then, if a person has an Advantage plan, they have January, February, and March of the next year to actually make a one-time change if they need to.

Jamie: Oh, interesting. So you talked just a minute ago about if somebody is late in enrolling when they're supposed to. What do they do?

Debbie: They can still get some assistance to apply. Like I said, they may have a penalty if they are not on creditable coverage. It's very important for veterans to know what their options are when they turn 65, because some of the VA plans—the prescription coverage or the medical coverage—might not be creditable in the eyes of Medicare. So you have to make sure that if you are supposed to enroll in Part A and Part B (Original Medicare), even if you're a veteran, you should make sure you know what you're supposed to do.

Jamie: Okay. And then let's just talk quickly about when folks enroll. Let's say it's the first time, and then the annual enrollment comes around and they enroll again—they can make a change. Then you fast forward a year from then, and the enrollment period again is October 15th to some date in December. Do they have to re-enroll every year?

Debbie: So it's automatic. They should review because plans change so much year to year. They should have an annual review of what their benefits are.

Jamie: And this is individual-based, right? So if it's a spousal situation, they could, in theory, have two different plans if that was their wish?

Debbie: They could.

Jamie: Okay. Anything else that you want folks to know before we close today?

Debbie: I think we've covered the basics. An individual can go to the Social Security website, ssa.gov, and start the enrollment process for—whether they're collecting Social Security or not—they can start the process, the application online. That's what I help people do.

Jamie: Oh good. Yeah, I'm sure that's very helpful. I know I went through kind of a training with Debbie and one of her associates recently, and they drew me a roadmap of how this all works and intertwines. I know that she does this when folks sit down with her. It was so helpful for me to see that, which is why I wanted to have you in the studio, because I never really understood how everything works together and supplements each other and why some people choose this and other people choose this. I knew a little bit, but you are truly the expert.

Debbie: I try to keep up.

Jamie: Well, thank you so much, Debbie, for being in the studio. We are so grateful for the folks that come and spend time helping us to educate folks here in southern Oregon, but this information is applicable statewide and quite possibly across the country. I'm so grateful.

If you have any questions or you need to get in touch with Debbie, you can look her up—Debbie Hodgson. You can look her up at Atrio; she works there and various other organizations. Or you can always call us. As I always say, Team Senior is accessible essentially 24/7. I encourage people not to call me at 2:00 AM because they're probably not getting back to you until the morning, but you can always call us. We are the company that answers the phone every day of the week, no matter the holiday, no matter anything. And we can definitely get you connected to Debbie.

Debbie: And I will be at the senior fair in September at the fairgrounds.

Jamie: Oh good. Yeah, the senior fair. So the senior fair in Grants Pass at the Josephine County Fairgrounds—that is on September 12th. She will be there and various other places. You'll definitely see Debbie around. She is recognized as an industry leader, and so we're very happy to have her here today.

Thank you so much, Debbie, and have a great day, everybody. Thank you for listening to the Team Senior Podcast. We're here every week sharing new and relevant information. Remember that we're just a phone call away. Team Senior can be reached at 541-295-8230. Again, 541-295-8230. Until next time, this is Jamie Callahan.