If You Think Medicare Is Free… Think Again!

You do not have to be collecting social security to go on Medicare. You just have to be 65 years old. And deal with an advisor, somebody who can take you through what you have and make sure it’s the right thing.–Marty Silbernik

Our guest in this episode is Marty Silbernik (954)993.9339, a Medicare Enrollment Specialist with United Insurance. Marty is going to debunk some of the most common myths surrounding Medicare.

I typically consult with 10-12 families a week on average regarding their long term care needs, and I was blown away 💥 by the level of craftsmanship Marty has on the topic!

Join the conversation below 👇👇👇

[I also provided the full transcript so you can read it at your own leisure!]

Claudio Alegre: What’s up everybody. And welcome to The Daily Pill, a webcast sponsored by our parent company, Angel Home Care Services and agency educating and providing caregiving services to the Miami Dade and more rural communities right here in South Florida. All right. So today we have you know, a special guest on a special topic on the topic is Medicare and and the other special person is Mr. Marty Silbernik. Marty, he is, well, he’s got a resume, which I’m not going to read the whole thing, but I’m just, you know, he’s native from Chicago. He began his career in marketing. He became executive. And then he had a couple of restaurants.

And then he kind of pivoted into Medicare and that has been his core specialty right now through United Medicare agency in Boca where his company has offices, he offers Medicare supplements, advantage plans, and drop plans for all the major players in the Medicare industry. United healthcare America, Humana, Aetna mutual of Omaha, and WellCare.

And so his focus right now is pretty much like me, right. He spends most of his time educating people buddy, welcome. Thank you for taking the time to be here. 

Marty Silbernik: Thanks for inviting me. It’s a pleasure to be here. I’m excited about doing this. It’s a fun way to spend some time and educate some people.

Claudio Alegre: All right. So do you remember what we titled? So I called, I called Marty last night and I said, Hey, Marty, you know, we need a good hook, a good title, man. You know, you’re the expert. What do you think we should title this thing? Right? And that you remember what we came up with. 

Marty Silbernik: You know, I remember seven variations.

I don’t remember what the final one was, but something about if you think Medicare is free and I forgot the rest of the tagline. Yeah. If you think Medicare is free, think again. 

Claudio Alegre: All right. Yeah. I’m basically that statement grabbed me because the first thing that I asked you after you told me, what, what do you mean.

Right. And so what do you mean Marty? And then of course, I know that you’re going to go a little bit into a brief breakdown of what Medicare by definition is by practical definition. But, and then, then we’ll get into a couple of myths that I know we wanted to debunk, but let’s just start here.

Marty Silbernik: I can’t tell you the number of people who’ve come up to me or talk to me and say, well, why do I have to pay all this money for Medicare? I thought it was free. During the annual enrollment period, which we’re in the middle of now, you see all these commercials on television, zero premium free dental includes vision, no co-payments. (this episode was recorded in January of 2021)

And everybody accepts that as the gospel and thinks it’s free, what they haven’t told you. And what most people don’t understand is that when you go in and enroll in Medicare, there’s an automatic set of premiums that you have to pay, regardless of what plan you’re with. So I want to start with that because that’s the first base cost.

Medicare is in really three parts with Medicare advantage being the fourth part. There’s part a, which is hospitalization, which if you’ve worked in the United States for 10 years, it’s free, you’ve paid for it through your social security deductions and your payroll deductions. Okay. There’s Medicare part B, which is hospitalization and not hospitalization doctors outpatient care, durable medical equipment lab work, those types of things.

Part B comes with a premium. It is not free. There’s a premium of base premium of $148 and 50 cents per month for part B coverage, regardless of what Medicare plan you’re on, that’s the base fee. So you start at $148. 

Claudio Alegre: That comes out of your pocket?

Marty Silbernik: For many people that comes out of their social security.

If you’re not on social security, you get a bill quarterly from Medicare. Now there’s one catch with that one – If you’re a successful entrepreneur individual and make a lot of money, that premium goes up. The more you make, the higher it is and ranges from that $148.52 is as high as $504.90 cents, depending on your income level with income levels, over a 500,000, you’re looking at $504.90 per month.

And that’s a pretty substantial amount of money. So that’s the first part of Medicare that isn’t free. We start with that base. Okay. The next part is your prescription drug plan. The part D plan that everybody refers to, there’s a monthly premium for that that’ll range from anywhere from $13 to 67, or even $80, depending on the plan and the coverage and what you need.

So we have to add that on. Let’s start with base $148.50. Let’s use some round numbers, $150 for part B anywhere from 3$0 to $80, we’ll go in the middle at $50. So right now, you’re sitting at $200 bucks a month for Medicare as a base cost. Now on top of that, since Medicare part B only covers 80% of those doctor’s bills.

Outpatient bills, urgent care bills. Somebody has to cover the other 20%. And that’s you, and it comes out of your pocket unless you purchase a Medicare supplement. 

Claudio Alegre: Break that down even more Marty.

Marty Silbernik: Well that, depending on the age, as you’re coming in, it can take another two to three or $350 onto that monthly premium.

Okay. So with that, you get. Incredible coverage. You’ll never see a doctor bill. You’ll never see a bill from a physical therapist or an outpatient clinic. Everything is covered, but you’re looking at somewhere around $600. Right? So out of, out of pocket, talk about Medicare advantage, which takes part a part B and part D the hospitalization, the doctors and the medications rolls it into one plan.

Those are the zero premium plans, but those are traditional insurance. So with the zero premium plan, you have a copay to the primary care doctor, anywhere from $10 to $20, a copay to a specialist, anywhere from 30 to $50, you have copays to hospitals. You have copays for virtually everything that you do just like traditional insurance and those copays.

These can rack up to a substantial amount. How many plans are most plans have a maximum out-of-pocket and that could go anywhere from $3,500 to $10,000, depending on whether you’re a HMO PPO, whether you stay in network or go out of network. So there is a substantial cost tied into a intimate. 

Claudio Alegre: Wow. So before, you know, it, you could be, you could be $600, $700 out of pocket, easy, you know, depending on, and I know depending on your situation, right. 

Marty Silbernik: Well, and that’s the important thing when you’re dealing with Medicare, a lot of people don’t deal with Medicare properly.

They don’t line themselves up with somebody who really understands that and wants to educate them. So  they listen to the commercial though, call the 800 number and they’ll be locked into a captive agent. Somebody that just is there to sell the plans at a single company, as opposed to an independent group of independent agents.

Like I represent, you know, multiple companies. I have some work in Florida alone, probably somewhere between 70 and 120 plans that I can look at to custom tailor a Medicare plan for somebody and minimize the cost and maximize the coverage. 

Claudio Alegre: So as a consultant, right? You’re not pretty much captive to, you know, you have a portfolio of options out there and you grab the options that best suit, the needs of the person that you are helping.

Marty Silbernik: Absolutely. I go through a series of questions with my clients, identify what their needs are, show them the options. My firm belief is that if I inform them, if I educate them and they can make an informed decision, The coverage that they have is going to be right for them, both in the short and the long-term.

And that’s my goal in dealing with the clients that I deal with. 

Claudio Alegre: So, Andrea, hi, Andrea. So Andrea is saying in the comments  “I think I’m moving to Canada.” Andrea –  I don’t know if that’s the answer. My wife’s Canadian and she’s not going back there for healthcare. You know, she, she’s going to roll the dice right here in the us, but I think what you need is, is to link up with someone like Marty.

And I’m first and foremost on just about anything having to do with healthcare, educate yourself, get the right information, understand your baseline, and then go from there. Oh, Marty, a question …What do you call it when the Medicare is open for you?

Marty Silbernik: Okay. We’ll call that. We call that traditional medic traditional Medicare versus Medicare advantage. 

Claudio Alegre: Got it. So when it comes to traditional and the choice of traditional Medicare versus Medicare advantage, For a person to choose what, what’s the rule of thumb.

And I know every, every, every situation is different, but as a rule of thumb, what would you say? You know, if you’re healthy, right? Are you better off with a Medicare advantage? If you are starting to show pathology, you started to get sick, you know, is there such a thing as, as a rule of thumb when it comes to that. Can you could just quickly shed some light on that?

Marty Silbernik: The more you learn about Medicare, the more you learn, there is no rule of thumb unfortunately. The decision you make today, if you’re a helper, the individual and say, I need the zero premium. I’m not worried about the $7,000 out-of-pocket on a Medicare advantage plan. I’m going to go with that because it’s going to cost me less in the short run.

I just have to pay my part B premium. And then a year later you get sick and you have a series of whatever illness it is. You’re not going to be able to go back to the original Medicare very easily. You’ll have to be underwritten and you will wind up staying with that Medicare advantage plan for the rest of your life.

And if your health deteriorates, you’re going to be looking at that 6,000 to 10,000 or $11,000 every year versus traditional Medicare, where you’re at 3,600, let’s say $600 a month. Rough numbers, 600 times 12 is $7,200 a year versus. And that’s total coverage, no copays, nothing. You don’t have to worry about anything coming out of your pocket.

So again, the metric that I like to use is that only about 30 to 35% of the people on Medicare are on a Medicare advantage plan. The remainder are on medical, Medicare supplements. So there’s got to be a strong reason for that. And I think in the long run, depending on the individual it’s cost, now there is a time and a place for Medicare and Medicare advantage rather.

If you’re on Medicaid, if you have dual needs, if you have chronic needs, special needs, Medicare advantage plans may be the best way to go because they offer customized coverage. So again, there’s no hard and fast rule. There’s no what’s best for Medicare. It’s what’s best for the person. And that’s what we have to decide.

And that’s what we have to look at. 

Claudio Alegre: I get it. All right. So, don’t go by rule of thumbs. Don’t go by you know, just basically talk to an expert, you know who’s going to assess your situation and it’s going to help you to make the best decisions based on your circumstances, right?

Marty Silbernik: Oh, the best question you can ask your, your Medicare advisor is what companies do you represent and if he represents, or she represents. A host of the major companies, Humana United healthcare, United American neutral Walmart, you know, you’re dealing with an independent agent that can find the best plan for you.

If they say, well, I deal with United health care and preferred care partners. That’s the same company. They’re pretty much captive to the plans of that company. And don’t have the broad variety of options for you. 

Claudio Alegre: Okay. And as I understand it you also have enrollment periods for Medicare, correct? Which are, I think October, December, 

Marty Silbernik: There’s really two major enrollment periods for Medicare.

There’s the annual enrollment period that goes from October 15th through December 7th. Anybody can do almost anything during that, that time period, you can go from a Medicare traditional Medicare to a Medicare supplement back from one to the other. Everybody should be reviewing their prescription drug plans during the annual enrollment period because formularies and networks, everything changes year to year.

And you need to make sure that your plan still covers you appropriately for the follow-up. The second time period is right now, January 1st through March 31st, where let’s say you made a mistake, you screwed up, you found out that your doctors are not on the Medicare advantage plan that you signed up for one time shot during that period to go back to original Medicare or roll into a different Medicare advantage plan to take care of the mistake that you may have made.

So those are the two primary periods there’s other special enrollment periods throughout the year. Way too detailed to get into tonight, but sure. If anybody’s curious, they just have to reach out to their specialist. 

Claudio Alegre: Yeah. And then there’s a way around it. If you’re stuck in something that’s not, you know, it’s, it’s there’s, there’s there’s no, there’s a way around any changes that you gotta make all year round, if you absolutely had to.

Marty Silbernik: There’s always a way around it. We can, we can, we can find something more often than not.

Claudio Alegre:. Is there any question that I should have asked you that I haven’t asked you? Even though we only have 15 minutes, we have like two minutes left, but is there anything that I, that I haven’t asked you that I should be asking you?

Marty Silbernik: Well, there’s only one thing that I want to let people know because that’s the other question that we talked about earlier. You do not have to be collecting social security to go on Medicare. You just have to be 65 years old. And deal with an advisor, somebody who can take you through what you have and make sure it’s the right thing.

There are people out here that are eligible for Medicare, but have no business going on Medicare because they have great employer coverage. And I’m not going to take somebody off a great coverage and put them on Medicare until I absolutely need to, or they absolutely require it. Those are the two things.

Claudio Alegre:  

Okay. So we debunked two myths today. I know there’s a few more, because I know you’re the master of Medicare. This makes for a great cliffhanger, which I know like how many of these myths do you think are floating out there that need to be completely debunked?

Would you say what, like 10, 12, 15 of these, or, or it’s just more like, you know, four or five of the main ones that people you know, are. 

Marty Silbernik: I I’ve been doing this for about 12 years. And every time I turned around, there’s a new myth that needs to get. People have such a misunderstanding of Medicare that it really becomes critical for them to, to take the time, to learn what they’re doing and not make a mistake that could cost them thousands.

Claudio Alegre: Cool. So Marty. 5  minutes left just when I’m starting to have fun. So that means that we’re going to have this, do this again, man. We’re going to have the, yeah. You know, so thank you so much. This has been invaluable. I I’m going to get a transcript of this and I’m actually going to create a blog post of it on a text format.

And then I’m going to put that out there as well and on a Q and A format Then that would be that will be beneficial. I’m also going to, I know that would being flashing your phone and your information on the screen, but I’m also going to put it in.

It is actually going live on Facebook right now. So I’m going to put all your information accessible for everybody to have a, so if a question is to reach out to you, you know? 

Marty Silbernik: Oh, absolutely. Absolutely. And if not me just find the right person, somebody you’re comfortable with with knows Medicare. 

Claudio Alegre: Awesome.

You’re very, you’re a very humble man, but he’s the guy by the way. All right. All right. All right. Thank you, Marty. I’ll see you soon, buddy. All 

Marty Silbernik: right. Bye-bye okay. Bye-bye.

Untitled designClaudio Alegre is the CEO & Chief Content Writer for Angel Home Care Services on the Web and Patient and Family Advocate off the Web. He lives in Miami with his wife and 3 boys. He's passionate about healthcare and all things caregiving. He can be reached at [email protected] or directly at 305.220.4544
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