Chatting about Medicare with health insurance agent Karen Frascone
Carla Christian
One of the most perplexing questions at retirement is how to sign up for Medicare. There are many options to choose from, strict deadlines to meet, and potentially long-term impacts on your retirement budget. I had a chance to chat with Karen Frascone, an independent health insurance agent in Independence, Oregon, to get the answers you need about Medicare.
What is your role as a Medicare health insurance agent?
This is my twenty-fourth year as a health insurance agent. In the Willamette Valley, we have 10 health insurance carriers offering 44 plans, plus Medigap options. As an independent agency, I complete training each year to be certified to offer Medicare plans. I am also trained and certified by each health insurance carrier I represent.
When I meet with a client, I spend a good amount of time to be sure I’m matching them with the best plan for their needs and their location. We talk about things like where they get health care, which plan covers their prescriptions, and how often they spend time outside of Oregon.
I start all appointments with a bit of history so clients understand the differences. Medicare goes back to 1965, when healthcare was a lot different. There was not a lot of outpatient care, so Medicare Part A was designed to pay 80 percent of hospital care. Part B, dubbed Medical, was created to cover outpatient care. Later, rising use of outpatient care led to premiums for Part B. In 2023, the standard Part B premium is $164.90.
Medicare pays for 80 percent of hospital costs and outpatient costs, so Medigap supplemental policies were created soon afterward to cover the other 20 percent. Part D was created to help insure the rising cost of prescription drugs in 2003. Medicare is kind of a miracle but it is missing modern benefits like vision, dental and hearing. Medicare Advantage plans were created in 2003 to allow health insurance companies to modernize Medicare, add additional benefits, and combine all of the Medicare A and B benefits and prescription drug coverage in one.
Agents are a no-cost resource for our clients. We know inside and out how carriers cover particular drugs, and we can interpret insurance terms so people understand confusing termin-
ology and how that translates into real life. I get to know my clients personally, so they even come in to catch me up on their health and family.
What are my choices when I sign up for Medicare?
When you turn 65, you have two broad choices.
Option 1: You can enroll in Medicare. A Medigap plan covers most of the 20 percent of hospital and outpatient costs not covered by Medicare, and a separate Part D plan covers prescription drugs. The downside is that this is expensive and has no vision, dental or hearing coverage.
Option 2: You can choose Medicare Advantage. This coverage was created 25 years ago by health insurance companies. They get a slice of the money from the Medicare pot, and have to provide at least what Medicare Part A covers. Advantage covers prescription drugs, dental, vision and extras like medical transportation and gym memberships. Premiums are much lower than Option 1, but you do share the cost for your medical expenses. Medicare Advantage plan offerings vary by county. When you choose a Medicare Advantage plan, it’s important to verify that your providers are in the plan’s network and that you understand the copays and cost sharing.
What is the most important thing people should know about Medicare?
Make sure you know when to apply, and when you need to enroll in Part A and B. Contact an agent or Social Security ahead of time so you have clear facts.
How should I choose between Medicare and Advantage?
Some of it is personal preference. When I meet with a client, I start by going over the options they want. We discuss the pros and cons of premiums, and the pros and cons of an Advantage plan. Education and dialog are so important. I ask the right questions so I can understand from their answers what’s going to be best for them. When should I start thinking about my Medicare choices?
If you’re still working for an employer with at least 20 employees and you’re covered by your employer’s group plan, you don’t have to do anything. Begin to consider your coverage three months before you turn 65 or your planned retirement date and loss of employer insurance. This is crucial if you are enrolling in Medicare Parts A and B because there can be delays processing enrollments at Social Security. Recently, there has been as much as a six-week wait for phone appointments to complete Medicare enrollment.
Do you recommend reviewing my plan choices every year?
If you’re happy with your plan and nothing has changed, there’s no reason to do anything. If your plan has changed or you want different coverage it’s time to review your choices. The Annual Election Period is October 15 to December 7. During this time, you can change from one Advantage plan to another, or change from traditional Medicare to Advantage. You can only change from Advantage to Medicare during certain periods or circumstances, and your
ability to purchase a Medicare Supplement may be affected by pre-existing conditions.
What is the biggest mistake people make regarding Medicare?
The biggest mistake I see is missing or not understanding enrollment time periods. For example, someone who continued to work and was covered by their employer plan but had been paying a Part B premium unnecessarily, or another person who was on the Oregon Health Plan and didn’t realize they must sign up for Medicare when they turned 65. Delays can be costly and result in gaps in coverage. People make the mistake of not getting help and not asking questions.
Is there anything I haven’t asked you about?
You didn’t ask me about why I’m the purple lady! I’ve been the lady with purple cards for 24 years. I have purple hair, my office is purple. Purple is the color of passion and I’m passionate about people having the education and knowledge they need to make the right choices for them.