The podcast, "Open Forum in the Villages Florida," aims to provide insights into the happenings in the community. It is listener-supported and offers shoutouts to supporters. Season 4 brings improvements, including the use of AI voices. The host interviews Jim Bodner, a resident of the Villages, who shares his background and involvement in various organizations. They discuss the differences between traditional Medicare and Medicare Advantage plans, emphasizing the importance of understanding monthly premiums, out-of-pocket costs, and rules on hospital and doctor usage. They compare a hypothetical Medicare supplement plan (Medicare G) with an Advantage plan (HMO), highlighting the advantages and limitations of each. It is crucial to regularly educate oneself on plan details as they can change annually.
Welcome to the Open Forum in the Villages Florida podcast. In this show we talk to leaders in the community, leaders of clubs and interesting folks who live here in the villages to get perspectives of what is happening here in the villages. We hope to add a new episode most Fridays at 9 a.m. We are a listener supported podcast. You can become a supporter for as little as $3 per month or you can choose to pay more.
To become a supporter go to openforuminthevillages.com and click on support in the black box. There will be shout outs for supporters in episodes. In season 4 we have made some dramatic improvements and changes. First is a clarification of the podcast's title. It is Open Forum in the Villages Florida to make clear that this is a regional show independently produced for folks who live in Central Florida and the villages areas. Second is a dramatic increase in the use of AI in the creation of each episode.
In fact the show's announcers are now all AI voices including me, Emily. Hope you enjoy. This is Mike Roth here on Open Forum in the Villages Florida. I'm here with Jim Bodner. Jim thanks for joining me. Thanks Mike, pleasure to be here. Jim why don't you give our audience a little bit of information about your background before you came down here to the villages. Mike and my wife and I have lived here in the villages now for about eight years but we spent most of our adult life in Michigan.
I'm a retired lawyer and my wife and I owned a long-term care business for 25 years. We've been down here eight years. We love the lifestyle here in the villages. Mm-hmm and in the villages what activities you involved with? Very active with a number of organizations. I'm the president of the villages chapter of the National Retiree Legislative Network. It's a nonpartisan nonprofit organization that advocates for issues that impact retirees. I'm also a real active member of Rotary.
We do a lot of work here in the community. I'm on the board of directors of Langley Health Services which provides medical, dental and behavioral health care services to low-income folks here in Florida. Mm-hmm. Jim why don't you tell us about your opinions about traditional Medicare versus the Medicare Advantage plans? It's a topic I talk about regularly. It's a topic that the National Retiree Legislative Network has some very strong opinions. But let me why don't you just back up and explain how the process works.
The key to this whole process is for every single one of us and there's 60 million of us on Medicare that we educate ourselves that we understand how the system works. But let me back up and walk through. All of us turn age 65 at one point in our lives and at 65 we're kind of at a crossroads. At 65 we're eligible for Medicare Part A which all of us get and it covers in hospital stays.
People get to whatever have a work history get Medicare Part A at no cost. Mm-hmm. And they also sign up for Medicare Part B. Medicare Part B covers outpatient, doctor's visits, medical equipment, those kinds of things. And we're all we all have to sign up for Medicare Part B. But if that's all we had if all we had was Medicare Part A and Part B we would be subjected to significant out-of-pocket co-pays and deductibles. So what do people do? They fill those gaps with a Medicare supplement.
And Medicare supplements come in two varieties. A person can either fill those gaps with what's called an Advantage Plan or they can fill those those holes with what's called a Medicare supplement. Let me explain how the two work. Mm-hmm. But let me reduce the comparison of those two options to three questions. And think carefully and write these questions down because these are the questions that in my opinion are important to ask regardless of the program that you that you sign up for.
And Jim, people will be able to read these questions in the transcript of the show which is available on the website. Great, great. Question number one. Regardless of the plan that you sign up for, what's the monthly premium? Okay. Preston, question number two. What is the maximum out-of-pocket co-pays and deductibles that you could incur in any one year? And question number three and what in my opinion is the most important question is what are the rules on the use of hospitals and doctors? So now let's apply those three questions to a hypothetical Medicare supplement.
Mm-hmm. Let's talk about the plan that in my opinion is the Cadillac Medicare supplement. It used to be the Medicare supplement F plan was the Cadillac as of January 1st 2020. You can't sign up for a Medicare F plan anymore. But you can sign up for the Medicare G plan. What's the difference between F and G? There's only a minor technical difference. If you've got a G plan, you're gonna you're gonna pay the first $200 of out-of-pocket Medicare Part B expenses which is your first doctor's appointment in January.
And after that there are zero co-pays and deductibles. Okay. The F plan there was zero co-pays and deductibles period. So there was a minor difference between an F and a G. The G in my opinion is the current Cadillac. If you've got an F plan, your grandfather keep it, you'll love it. It's a great program. But let's apply those three questions to this hypothetical G plan. You sign up for a G plan at age 65. That G plan is going to cost depending on your age and your zip code $150, $175 a month.
Again it's gonna you can go to Medicare.gov and get an exact quote. But approximately let's call it $175 a month. You've got to buy a separate drug card. A Medicare D drug card. So let's say that drug card costs 200 bucks. So the total $25. So the total cost of the G plan and the drug card is $200. That's your answer to question number one. Question number two, what are the maximum out-of-pocket co-pays and deductibles that you could incur in any one year? And the answer to that is 200 bucks.
You're going to pay the first couple hundred dollars of Medicare Part B expenses which you're going to incur in January. After that there are zero co-pays and deductibles. My third question and again in my opinion the most important question, what are the rules on the use of hospitals and doctors? The answer to that is there aren't any. You can go to any Medicare doc, any Medicare hospital in the United States that will accept Medicare and virtually all of them do.
And I like rule that I like to apply is apply the Mayo Clinic test to the plan that you're looking at or the Shands test or the Moffitt test or the Cleveland Clinic test or any of the premier facilities here in the United States. Apply and ask yourself if one time in my life I needed access to Mayo Clinic or Shands, can I get there? With a Medicare G plan you don't need a referral, you pick up the telephone, you call Cleveland Clinic, you call Mayo Clinic, you call Shands, you schedule an appointment.
When you get there you're not going to have any co-pays and deductibles. Let's apply those same three questions to an Advantage plan and to keep things simple you got to understand that every Advantage plan comes in two varieties. Either it's an HMO or a PPO. So those Advantage plans are all limited plans with limited group of doctors and HMO means? The health maintenance organization, the HMO is the most restrictive. It's going to have a closed network of doctors that you're required to go to.
You're going to need a referral to get to that doctor. Inside the network? Correct. Now a PPO permits you to go outside the network. A PPO means? It's a preferred provider organization. You can go outside the network, you'll pay a higher co-pay and deductible but it does permit you to get out of the network. But let's apply my three questions to, let's talk about an HMO. You could get an HMO in our local zip code here in the villages for as little as zero additional dollars above the cost of Medicare Part D.
Okay, zero, zero, zero. So answer the question number one, you can get the Advantage plan, the HMO and it will include a drug card for as little as zero dollars a month in premium. Some of these plans actually say you're going to get so many dollars a month back, up to $175 a month back on your Medicare. That's true and to that I say, are you buying a health club membership? Is that what you want? Yeah, they give you the golden sneakers.
Right, are you looking for a health club membership? Are you looking for the best medical coverage available in the United States? Or are you going to take the risk that when you need to go to a place like the Mayo Clinic that you can endure a couple of hundred thousand dollars worth of medical expenses? Well, there's going to be a cap if you can get to, there will be a cap on an Advantage plan on your maximum out-of-pocket co-pays and deductibles.
In 2024, I think the number is like $7,500 so it will cap it. But the question is, can you get there? Can you get to that facility without a referral? So if you took my hypothetical HMO, the monthly premium is, and a drug card, it's $0. What's the maximum out-of-pocket co-pays and deductibles that you could incur in any one year? Every single HMO, every single PPO is going to be different. The maximum hard cap in 2024 is $7,500.
So there is a cap on the maximum but you could incur that maximum cap. In your plan, you have to look at your plan. You have to look at the details of your plan. Every Advantage plan is different and every Advantage plan can change every year. So you've got to be very educated in what your plan consists of. The third question, Mike, and again, in my opinion, the most important, is what are the rules on the use of hospitals and doctors? If you've got an HMO, there are a lot of rules.
If you've got a PPO, you can go out of network. But you need to educate yourself on the rules. You need to educate yourself every single year because that plan can change every single year. Yeah, well, I've heard cases where people thought they were covered and they could get into Shands and a couple of years later when they tried to, they discovered they weren't covered. You know, I've heard all the horror stories. What I tell people is educate yourself.
The worst person to buy insurance from are the TV ads that you see. Don't buy Medicare coverage based on television ads. Buy the Medicare coverage or acquire the Medicare coverage based on your knowledge of the system and your individual personal and financial needs. And I'll give you an 800 number here, Mike, there's a volunteer group of folks here in Central Florida that are knowledgeable, that will provide you one-on-one objective counsel on these Medicare options. How many options are there? How many Medicare plans are there? Advantage plans, could someone in Florida buy? Boatload.
Boatload means? A dozen. Yes, and every zip code will be different. Every zip code is different? Every zip code is different. You've got to go to go to medicare.gov, answer a few questions, put in your zip code, and it'll tell you what advantage plans and what Medicare supplements are available in your zip code and the cost of each of those plans. So let's compare and contrast my hypothetical HMO versus my hypothetical G plan. Which is more expensive? A $200 a month premium for the Medicare G plan and a drug card, separate drug card, or a free HMO, zero premium HMO? Which is cheaper? Well, zero is naturally cheaper.
Well, is it? Is zero cheaper if you've got a five or six or seven thousand dollar maximum co-pay and deductible in any one year with that HMO? Is that cheaper than two hundred a month? Well, I'll ask another question. You know, in medical school, it seems to me that there were A students, maybe A plus students, B students, C students, D students. Who do you want to be your doctor? The A student or the D student? Well, yeah, I don't want to say that the docs in a Medicare Advantage plan aren't good docs.
I know they are and I know there are some very good docs. What I do want to point out is that some of the best physicians in the world work at Shands, work at Mayo Clinic and Cleveland Clinic and Moffitt and other names that you're all familiar with throughout the United States. You may need specialized care. You may need something that isn't available here in the net. Where are you going to go? And can you get there without a referral? Do you want someone making a referral or do you want to just pick up the phone and call Cleveland Clinic and get a second opinion? Maybe you're getting an opinion from a local doc and that's great, but maybe you want a second opinion from someone at one of these specialized care units.
Let me ask you a question, Jim. I have noticed that my own personal physician, he has a new sign out of his office. It says, starting January 1st, we're not going to accept these Medicare Advantage plans and he listed some of the popular ones that were displayed on TV. Yes. Why do you think that is? Well, let me tell you a real story. Sometimes personal stories weigh very heavily, but a couple of years ago, I had a urologist did an MRI of my prostate and found a shadow and he said, Jim, 50% chance it's a problem.
If I go in and biopsy that right now, there's a 15% chance that I could biopsy it and come back with a wrong diagnosis, with a negative diagnosis. What I would like to do is do a second MRI and create a 3D image of the prostate and go in with 3D imaging equipment and biopsy it and I guarantee I won't miss it. He did and fortunately for me, everything was negative. But when he's talking to me and he knows my background and he knows that I'm pretty conversant on some of these topics, he comes about a foot or two off of his chair when he's talking to me about these issues.
He says, Jim, here's the deal. If you were in and he listed some HMOs, I wouldn't have gotten approval on the second MRI and I'd have gone in and biopsied it with a single MRI. You have to have someone approving those procedures. When you're in an Advantage plan, your doc has to recommend the process you need but it also has to be approved by the administrative arm of that Advantage plan. If you have a Medicare Supplement G plan, your doc codes it with a Medicare code, you get that MRI.
I got that second MRI. I got the 3D imaging. Fortunately for me, everything was negative. But getting that approval might add critical time to the time from initial diagnosis to treatment that you really can't afford. That's very true and again, I'm an advocate. I personally prefer the Medicare Supplement track. I'm an advocate for it but I don't tell people what to do. What I do try to do is educate people so they're knowledgeable about these options so that when they sit down with their insurance agent, they know as much as the agent.
Good. Jim, let's take a quick break here and let's hear an Alzheimer's tip from Dr. Craig Curtis. Dr. Curtis, several new medicines have been approved by the FDA for the treatment of Alzheimer's. How effective are they? So the effectiveness so far shows an approximate 30% slowing of Alzheimer's disease when these medicines are used in patients with the very earliest stages of the disease. With over 20 years of experience studying brain health, Dr. Curtis's goal is to educate the villages community on how to live a longer healthier life.
To learn more, visit his website CraigCurtisMD.com or call 352-500-5252 to attend a free seminar. I'm back with Jim Bodner and we're talking about the difference between Medicare plans and Medicare Advantage plans. Unfortunately, those two names are so similar. I believe they must confuse a lot of people. They do. They do confuse a lot a Medicare Advantage plan and a Medicare supplement. They are confusing. You as a enrollee need to know the difference. As I mentioned before our break, you need to know the difference.
When you sit down with your insurance advisor, you need to make sure that advisor can explain the pros and cons of an Advantage plan versus a Medicare supplement. And I also recommend that you get one-on-one advice from a group called Shine. You were going to give them our audience their phone number. Yes, Shine is a group of trained volunteers who provide one-on-one counseling to Medicare recipients. And you can contact your Shine representative with this phone number 1-800-262-2243.
Let me repeat that. It's the Shine program 800-262-2243. They're a great organization. They're not going to tell you whether you should sign up for any specific plan, but they will work to educate you on the difference between Advantage plans and Medicare supplements. So that when you sit down with your insurance advisor, you can demonstrate to that insurance advisor that you know the difference. And make sure that your insurance advisor can explain the pros and cons of each.
So Jim, I like to put a little joke into every show for my grandson. That's good. Evan, yeah. Dinosaur jokes? Not dinosaur jokes, but funny jokes. We're putting it into the back half of the show today to make sure Evan listens to the show to find it. So Jim, what do you call, you know, we're living in a retirement community. We are, yeah. So what do you call a retired vegetable? A retired vegetable. Boy, you got me, Mike.
A has-been. Mike, can I tell that to my granddaughter? Sure. So I've run you through the kind of the decision tree, but let me explain something that you really need to keep in mind. When you, remember, we fast-tracked, everybody's 65 years old today, and we made that critical decision. What I didn't tell you is, once you make that decision, if you decide to go down the Medicare Advantage track at age 65, you may have committed and made an irrevocable decision.
Yeah, that's a lifetime decision. It's a lifetime. Let me explain how it works. During that first year after your 65th birthday, you've got the right to realize, you know, I really wanted the supplement. I signed up for the Advantage plan. I'd like to change my mind. You can change your mind during that first year. Mm-hmm. But after that first year, you have potentially made an irrevocable decision. So that if you're in the Advantage track, you've got to stay there.
On the other hand, if you decided you wanted to sign up initially for a Medicare supplement, and you change your mind five years later, you can go from the supplement track to the Medicare Advantage track, no problem. But it's a one-way street, okay? You can't go from the Advantage track to this supplement track as a matter of right. You can apply. You can be turned down. You can be rated at a high premium. And like any rule, there are exceptions to the rule.
What are the exceptions? Well, I make a sporting event out of guiding people through the exceptions to the rules. A sporting event? Oh, it is. I have a low threshold of excitement. But let me give you an example I see all the, not all the time, but often. Someone has got an HMO, a very restrictive HMO, and they're from Pennsylvania. And they move to the villages, and that HMO isn't offered or available here in the villages.
That fact situation can give that enrollee what's called special enrollment rights. It gives that enrollee the opportunity to wind the clock back to age 65 and to go down the Medicare supplement track if they want to. They're going to pay a premium for that supplement based on their actual age, their current age. But they have a second bite at the apple to sign up for a Medicare supplement. That's the exception I see regularly. There's other exceptions.
An insurance company goes out of business. They're no longer offering that insurance. That likely can trigger special enrollment rights. But the general rule is you've got a one-year window from your 65th birthday to decide which track you're going down. Often people say to me when I'm talking to groups, and I talk to a lot of groups, well, geez, thanks for the great advice. You know, I signed up for this Advantage plan. I'm 75 years old. I signed up for the Advantage plan.
You've just told me that you like the Medicare G plan, but I can't get it because I don't have special enrollment rights. What do I do? And my answer is don't panic. Don't panic. What question of my three questions is the most important to you? If the most important question to you is the choice question, being able to go wherever you want, look during open enrollment, which we're in right now. We're in open enrollment. Look at moving from a restrictive HMO to a PPO.
The PPO will permit you to go out of network and seek health care providers at other locations, some without referrals. So don't panic. There's some really good PPOs out there that, you know, that are good. There will be a premium attached to those PPOs. Remember in my example, I told you the HMO might be zero, and there are zero premium HMOs. The PPO you're going to pay a premium for, a monthly premium. So don't panic. Educate yourself.
Know the options. Know what's out there, and become informed. And please, please, please, don't buy Medicare insurance from television ads. Don't buy Medicare insurance from television ads. Think about the Free Health Club membership, and if that's your criteria for buying Medicare, Golden Sneaker, whatever they call it. That's what they call it. If that is your criteria, that's not my criteria. My criteria is what is the best medical coverage available that I can get when I'm healthy, and what is it if I have that one-time-in-a-lifetime situation where I need specialized health care.
Mm-hmm. And you can't predict that. Unfortunately not. I often, often hear is, well, I'm healthy. I would prefer that zero premium HMO. I'm healthy. I've been healthy all my life. And to that I say, congratulations. Mm-hmm. But what's going to happen tomorrow, or the next day, or 10 years from now? Mm-hmm. Jim, why don't you tell our listeners a little bit about what's coming up in drug costs? Yes. This is an area that the National Retiree Legislative Network has been actively supporting, reducing the cost of health care.
And let me point out what the NRLN has been doing, what they've been advocating for, and what's come to pass. Effective January 1st of this year, if you're a retiree and you're on insulin, the cost of that insulin is capped at $35 a month. That is a big deal. That is a huge deal. Effective January 1st, 2025, a person's total out-of-pocket costs are capped at $2,000 a year. That is a very, very big deal. What's happening with that drug donut? The drug donut hole is shrinking over the coming years.
But when you get to a $2,000 maximum hard cap, that's a large deal. My daughter takes one drug, multiple sclerosis drug, that costs $9,000 a month. That's what, $100,000 a year? It's a $2,000 cap, and she is on Medicare because she's 100% disabled. Is a $2,000 a year cap a big deal? Uh-huh. It sure is, because a lot of people are taking these very expensive drugs. Today, today, it is illegal for Medicare to negotiate for drug prices, okay? Mm-hmm.
Medicare represents 60 million people. 60 million of us are on Medicare. On January 1st, 2024, that goes away and they can begin to negotiate. That's correct. And we have no idea how long that negotiation will take. We don't know, but we do know that Medicare can go to pharma and talk about the 60 million people they represent. And beginning in January, the list is 10 drugs that they can negotiate for. It's my understanding that list then will scale up over the next few years.
You know which 10 drugs they are? Well, I had a situation recently where it caught my attention when I saw the list. The number one on that list, my heart went into a-fib here a few months ago. I'm now on Eloquist, which is $500-$600 a month. Eloquist is number one on the list of 10 drugs. So the other nine have really long, complicated names, but they're all expensive. Mm-hmm. Good. Jim, why don't you tell us about Plan for Life Checklist? Yes.
And if you go to my blog, and I think my blog link will be on this podcast. The blog link is www.bodenerj.wordpress.com. And if you navigate to the file called Plan for Life Checklist, you will see a lot of really good information. You can download it. It's about a 30-page PDF file. Wow, 30 pages. I have a low threshold of excitement. There's a lot of loose facts floating through my head. And I've put those loose facts into this Plan for Life Checklist.
It includes things like you need to organize your life in a 6-inch thick 3-ring binder. And I give you the index of what should be in that binder. It should be in a safe in your home. It shouldn't be in a safe deposit box. But it tells your loved one. It tells your partner. It tells your children. Everything there is to know about you and where everything is. In my former life, my wife and I own the long-term care facility.
We saw all the train wrecks of people not knowing where documentation is. Mm-hmm. I deal with identity theft and fraud. A lot of good issues. I deal with zero-step design in single-family homes. I deal with... Zero-step design means... No steps. All of our homes here in the villages have those wonderful 4-inch steps. There's a way to get rid of them. There's a way to engineer them away in a first-class manner. How do you do that? You...
The front door is real easy. You simply raise the pavers up 4 inches. You have a train... You have a carpenter come in with a sawzall and get rid of all those 32, 33-inch doors and drop in 36-inch doorways. You go into your bathrooms and get rid of the big offender. I love garden tubs. They're great. If you like broken hips, they're wonderful. Get rid of the garden tub. Get rid of the shower that steps down.
Have a carpenter come in. Take 4 inches of concrete out. Replace it with 2 inches of concrete. Let the tile guy finish the last 2 inches. You've got a zero-step shower. Make sure you've got at least a 36, preferably 40, 42-inch entrance into that shower. You now have a zero-step bathroom. It can be done. There's engineering things you can do. We bought our house here in the villages. We completely redid it. It is a zero-step house.
Mm-hmm. And zero steps in from the garage? Yes. You can... Of course, you got to get rid of that 32-inch doorway. Mm-hmm. Not a big deal with the sawzall. And... Well, sometimes there's electrical inside that 4-inch... There is. Nothing an electrician and a drywall guy can't handle. But you knock the concrete out in a 4-foot by 8-foot section and front of the door. You taper it up to zero. Get rid of that 4 inches. I did it.
It worked great and re-glazed the garage floor. Looks wonderful. Great. Jim, thanks for being with us on this episode of Open Forum in the Villages, Florida. I'm sure we're going to talk to you again in another episode. Thank you so much, Mike. Remember, our next episode will be released next Friday at 9 a.m. Should you want to become a major supporter of the show or have questions, please contact us at mike at rothvoice.com. This is a shout-out for supporters Tweek Coleman, Dan Capellan, Ed Williams, Alvin Stenzel, and major supporter Dr.
Craig Curtis at K2 in the Villages. We will be hearing more from Dr. Curtis with short Alzheimer's tips each week. If you know someone who should be on the show, contact us at mike at rothvoice.com. We thank everyone for listening to the show. The content of the show is copyrighted by Rothvoice 2023. All rights reserved.
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