Business Innovators Radio - Interview with Paul Castner President of C & K Healthcare Advisors, Discussing Medicare

Episode Date: August 22, 2024

Paul Castner started out his path in the insurance industry by working at one of the Nation’s Top Medicare carriers. He began in the broker services department, under strong leadership who encouraged him to always pursue learning and trusting his skill set. From there he joined their sales team and had some of the best in class mentors along the way who not only strengthened his knowledge of the insurance products but also the importance it was to the population it served. C & K Healthcare Advisors was developed by Paul Castner and Mike Killmeyer based out of Pittsburgh Pennsylvania, with the concept of giving back to the generations that have came before them. What started out as an agency that only serviced Pennsylvania, Ohio, and West Virginia rapidly grew to now servicing the entire United States. Our agents live and work in your communities and we strive to be the face of comfort and trust. Our pledge to you is that we will always do our best to inform you of the options that fit your needs, lifestyle, and budget, while working ethically and doing what is morally right.Discover the peace of mind that comes with Paul Castner and his team of licensed consultants expert guidance—because you’ve earned a retirement that’s as fulfilling as it is secure.Call them today or visit their website at https://www.ckhealthcareadvisors.com/C & K Healthcare Advisors, LLC and their agents are licensed and certified representatives of a Medicare Advantage (HMO, PPO and PFFS) organization and a stand-alone prescription drug plan with a Medicare contract. C & K Healthcare Advisors and their agents are not affiliated with the United States Government or the Federal Medicare Program. Enrollment in any plan depends on contract renewal. Medicare is available to some individuals under the age of 65 in limited circumstances. Plans and products may not be available in all areas. Certain exclusions and limitations may apply. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1–800 MEDICARE to get information on all of your options.Influential Entrepreneurs with Mike Saundershttps://businessinnovatorsradio.com/influential-entrepreneurs-with-mike-saunders/Source: https://businessinnovatorsradio.com/interview-with-paul-castner-president-of-c-k-healthcare-advisors-discussing-medicare

Welcome to influential entrepreneurs, bringing you interviews with elite business leaders and experts, sharing tips and strategies for elevating your business to the next level. Here's your host, Mike Saunders. Hello and welcome to this episode of influential entrepreneurs. This is Mike Saunders, the authority positioning coach. Today we have with us Paul Kastner, who's the president of C&K Healthcare Advisors, and we'll be talking about Medicare. Paul, welcome to the program. Hey, thanks, Mike. Thanks for having me. Hey, so I know Medicare is a topic we can probably cover in about a minute and a half.

You know, ha, ha, no way. That's a topic that a lot of people do not fully understand. It can take days and days. And I understand there's a big old thick publication that, you know, the government assumes that we're going to read and understand. So that's what we're going to rely on you to kind of give us some clarity around. But before we dive into that, give us a little bit of your story and your background. And then what got you interested in becoming that medical? Medicare expert. Sure. So Mike, I've been in the field for almost 20 years now. I started working as a

national sales manager at one of the largest carriers in the country. In that time, my grandmother was still alive and my mom was an only child and her husband had passed away years before that spending time with her. I heard her say often to me that it's a shame when seniors have to struggle between putting food on the table today or paying for their medication. Every client that I work with, I hear her in the back of my head, and that's what drives me to do this. Wow. You know, it seems like the old concept of, you know, begin with why and then the how falls

into place. And, you know, your why is helping other seniors avoid that, you know, gut-wrenching feel that your grandmother experienced and, you know, very. voice to you. And when you've got that driving you, boy, who wins your clients? That's really powerful. So let's talk a little bit about Medicare. And I know that it's kind of a loaded question to say, what's the right choice of Medicare plan? Because it's not one choice for every single person. And you say next, you know, and here's your plan. But talk a little bit about how you start educating your clients on choosing that right Medicare plan.

Sure. So I have a colleague of mine. He's up in northwestern Pennsylvania, and he makes a couple of jokes. I use these to this day, Mike. So understanding Medicare is about as clear as mud, and it's as easy to understand is nailing jello to a tree. Now, what we have done so well was Medicare comes with a very large couple hundred page book when you turn 65 and you're aging into Medicare and you applied Social Security. We have been able to successfully, summarize that big book down onto one sheet of paper. And that's what I'm going to start off with on how to choose the right Medicare plan. Okay. So explaining that, real simple, you got to understand original Medicare first because everyone's asking me what's better. Medicare advantage or Medicare supplement, also known as Medicare. But to be able to make a decision, you understand original Medicare. Original Medicare, real simple, broken down.

You have Medicare Part A, which is your hospital insurance and Medicare Part B, which is your doctor's insurance. Medicare part A, you pay $0 a month. That came out of that Social Security tax that you were paying for years working at your job. As long as you have worked 40 quarters in your career while you were out in the field working, you pay $0 a month. If you were between 30 and 40 quarters, you pay $278 a month. And if you worked less than 30 quarters in your life, you pay $505 a month. Real simply put, original Medicare has $1.7.005 a month.

care has holes. So, hospital, if you're there for under 60 days, you have a $1,632 deductible, Medicare pays the rest. If you're there from 61 to 90, you have a $408 daily co-pay. Medicare pays the rest. If you're there 91 through 150 days, it's $816 a day co-pay. Medicare pays the rest. And if you're there over 151 days, well, guess what? You get hit with the full cost, daily cost. that 151 plus. That hurts, right? That's when Medicare supplements come into play. But guess what?

You also got nursing, skilled nursing care. So days 1 through 20, you pay nothing. Medicare pays at all. Days 21 through 100, you pay $200 a day. Medicare pays the difference. And anything over days 101, they're not paying anything. You're paying the full bill. Well, again, that hurts again, that population, especially on fixed income.

So Mike, there's gaps. Now you got Medicare Part B. Every one of us will pay the Part B premium no matter what we do. And that right now for 2024 is $174.70 a month. We will pay that when we turn 65 or older and we're on Social Security. Now there is something called Irma that you have to understand what that stands for is income-related, monthly adjusted amount. What that means is if you have a higher than normal income, which is for an individual $103,000 or joint $206,000, you will pay the $174.40. But if you earn more than that, you can pay upwards going all the way up to $594 a month.

Wow. That's what earning. Because they know you can afford it. Correct. So, again, you know, normally most people aren't going to have that big of an income in retirement. So therefore, they're going to pay the $1.70. 470, but working with a local value-added consultant that's licensed, they'll be able to help you to figure out what that arm is going to be.

Again, on that side, you have a $240 annual deductible on your doctor's visits, and then after that, 20% is what you'll pay. Medicare pays the rest. So we got large gaps here, Mike, okay? And what does that mean? Well, I got to choose. Do I pick up a Medicare supplement, also known as Metagap, get it? Metagap filling in gaps, or do I pick up a Medicare advantage?

Well, there's pros and cons to everything. So that's the second part of our one-sheater. We break it down. So let's go through the pros of Metagap. You've got plans A through N. Okay, and the beautiful thing is what carrier you're with, the coverage is the same amongst all the carriers. Now, every one of those plans have different percentages on what they pay.

We can go into that. I would suggest you doing that with a licensed broker. at the time. Okay, we don't want to do that on this interview. But that's how Metagap works. That's a pro, right? You know what your coverage is going to be. Here's the cons. You're going to pay a premium. You're going to pay that premium every month. And every year, either on your birthday or the anniversary of your policy, that is going to go up. And it could be a slight increase or it could be a large increase depending on how that Metagap insurance carrier is positioned. The other negative sizes, it does not come with prescription drug coverage.

And by law, you have to have prescription drug coverage. So that's going to be another premium. If you need dental and vision coverage, it's going to come with another premium and another policy. So there's pros and cons. The upside is if you expect in your lifetime to have high medical costs out of pocket, Medagat would work out well because you're going to pay those fixed rates in the premiums. And then from there, everything is going to be covered. as long as it's Medicare-approved procedures.

On the other side, we have the pros and cons of Medicare Advantage. Medicare Advantage was built as an all-encompassing plan, meaning your dental hearing vision is going to be in there. There's going to be some other perks. The costs are what they are. Now, most of the time on Medicare Advantage, you're paying a low premium or no premium, right? So that sounds great, okay?

Much better than the higher side on the Metagap, But the cons on that side is instead of having the high premiums, you're going to have co-pays, Mike. And that becomes dangerous. As we get older, we know our health starts to deteriorate, right? So maybe you're healthy when you signed into a Medicare advantage. And now I'm, you know, 80, 85 years old and my health's deteriorating. And now I've got a co-pay burden. But, Mike, we got answers for all of that.

And, you know, if you tune back into another one of our podcast, you'll hear more in depth on there, but there are ways to protect yourself from the co-pay burden. So again, going back to your question, what is the right choice for Medicare plan for a senior? Well, there's not a perfect answer. It all comes around that person's budget, what they're looking for and what their needs are. And working with a value-added licensed consultant, they'll be able to explain the pros and cons of both programs, figure out what that person's needs are and then guide them into making the decision that works out best for their particular needs. You know, all of that was a huge mouthful.

And for you to have given that 30,000 foot overview of the one pager that replaces 200 pages of just confusion is spectacular. And then I like that you did not get in the weeds and go, oh, and then this and this and this. It's now it's like, okay, if this sounded a lot simpler than what you were assuming for, Medicare, get with someone that can take your personally situation and match up the needs by asking questions. So that's a huge, huge opportunity that I think you've done the heavy lifting for. So that's a great overview on those plans. What's the best one?

There's not the best plan for everyone for every single situation because everyone is different. So let's move on into some of the other things that people need to kind of start considering. Once they start clarifying and zeroing in on the right plan, what are some of these governmental impacts like Biden's, you know, inflation act and things like that? How does that affect Medicare beneficiaries? So, Mike, I'm glad you asked that question. So this year coming up, annual enrollment period starts October the 15th, runs through December the 7th. And this is going to be one of the biggest years in the history of Medicare. What do I mean by that?

There's going to be so much confusion and uncertainty because of the way Biden's administration's inflation reduction act will affect Medicare Part D particular. Okay. So first off, the idea of the inflation reduction act was meant to stop the burden of these high-cost pharmaceuticals that has been brought on by the pharmaic pharmaceutical companies. Big Pharma has not been friendly to the people of the United States. And I get it. I understand. There's a lot of money put into developing and testing and everything else. And that burden and that cost has to be spread out. And unfortunately, us, the consumer faces that. So what Biden's administration did was come up with the Inflation Reduction Act. And it has its pros and its cons. So let's always start out with the best place. Let's talk. talk about the positives of it before we get into the negatives, because I don't want everybody to think that it's all bad. So one of the main points here is insulin. Those who are diabetic

have faced that cost of insulin prices at the pharmacy for a long, long time. Insulin now will be available at $35 per month per covered prescription. That is a huge plus for the diabetics that are out there. The other positive pieces are, the access to recommended adult vaccines without cost sharing, meaning, you know, like shingles, things like that, that those vaccines were expensive for a while. Seniors will now have access to it at no cost out of their pocket. There used to be this piece in Medicare called the donut hole. I'm not going to get into that.

Those that are listening to this understand what the donut hole was, especially if they were affected by it. But the donut hole is going away. That's why we're not going into it. Why bring up old things that caught a negative reaction, right, if we don't have to. And it sounds like it was bad enough that someone raised their hand and said, we need to eliminate this and then now that's being eliminated. So that's good.

Correct. So the positive side, now that the donut holes going away, there is a yearly cap of $2,000 starting in 2025 on out-of-pocket prescription drug costs in Medicare. So those people that have very pricey drugs that was costing them thousands upon thousands a year. Now there's a cap at $2,000. Once they have $2,000 out of pocket, their carrier pays the rest of the year of their prescriptions at 100%. That's beautiful. That's a beautiful thing.

Another positive. The other big thing was the expansion of the low-income subsidy program. Us as agents know it as LIS or people out that are effective. with low-income subsidy, know it as extra help, under the Medicare Part D to 150% of the federal poverty level starting back in 2024. So that means now that people who are below 150% of the poverty level, now they're getting extra assistance, which will help and cut those costs down yet again. So there's the positives of that, Mike. You understand those are some key points before we get into the negatives. Well, and the positives sure sound like it's a positive.

impact on my back pocket. It absolutely is. But now we got to think about this from a business side for a second point. Okay. If it is positive for you, it's saving some money in your pocket, right? But that, the brunt of that is now being burdened by the insurance carrier, right? That means there has to be with every, with every action, there is an opposite reaction, right? So here are some of the possible. These aren't set in stone yet, Mike, but possible negative effects. The first one that we got to talk about is higher plan premiums. Remember, we just discussed premiums when it came to MetaGap and that prescription drug cost,

while higher plan premiums can be one of the effects because, of course, the insurance company, if they're paying a lot more out of pocket because of that $2,000 cap, has to be able to recoup some of the costs. otherwise they're out of business. Yep. Right? Makes sense. The other piece is a little bit of a narrower of the drug formula.

So every prescription is on a formulary and there's tiers, tiers one through four and then tier five, which is specially meds. Well, you might see some things that were a tier two drug now get bumped up to a tier three. You might see some drugs come off of that carrier's drug formula saying, hey, we can't afford to cover that drug anymore. You know, can you check with your doctor to see if you could take the generic? There's a million different things could happen there, but they might narrow their formularies.

Reduction of plan benefits. Remember, when I talked about Medicare Advantage, I said, hey, it's all encompassing, all in one. Dental hearing and visions in there. There's a lot of extra little perks. People that know Medicare Advantage, they love the flex card. Okay, a flex card gave them, you know, healthy food and produce, spending, tons of other benefits like transportation, gym benefits, okay? Well, we might see some of those benefits

reduce. Some of that dental hearing and vision covers that you were used to, yeah, it's not going to go away, but what you were used to receiving per year, that might get cut back a little bit. Again, the carrier's got to save some money somewhere because of the inflated costs on the prescriptions. Network adjustments, okay? Some of these carriers might address their network. They might not have as many doctors in network. They might not have as many pharmacies. Maybe, you know, one of the big pharmacy chains were preferred and now they're standard. Well, the difference between preferred and standard is the drug prices. So you might see a little bit of network adjustments. And then the last thing that we are expecting is increased utilization

management. And I know that sounds really complex. But for people that are on Medicare, they're going to understand a couple of things here. The term prior authorization, some of these drugs require that the doctor sends in prior authorization, which they have to explain why it's medically necessary, that they're prescribing that person, that particular drug, and they might tighten that up a little bit. And then step therapy. Sometimes they want you to try these series of drugs first before they will approve this particular drug.

Why? Because the cost is down a little bit. those drugs do basically the same thing or exactly the same thing. But step therapy was a way to keeping the cost down to. So we would expect maybe a little bit of a stricter protocol around prior authorizations and step therapy to control those costs. So from all of that, it sounds to me like the old saying, the only thing constant is in life is change.

So we know that. So what I would say is, you know, sometimes you were saying, you know, this could happen, this might happen. So all these aren't in process, but these are the things that probably are looming. But one of the things that kind of hits the back pocket that makes the most immediate sense, if these carriers are forking out more coverage, the premiums, plan premiums, probably are going to go up. Is there a feeling for what percent increase that could be? So it's still early on, Mike. I mean, we won't usually see those and we can't see the upcoming plans until October 1st of the plan year.

So we don't have a vision yet, okay? We have in the industry what we know is first looked. Their early guesstimates of what each plan are going to look like. And the reason why I'm saying guesstimate is because nothing is official until it's blessed by CMS, which is the Center for Medicare and Medicaid services. Okay. So the carriers are letting us as brokers see the plans a little early, having an idea what the market's going to look like, but we know there could be minor tweaks or changes per until CMS

has that official. And we can officially market and officially talk about it. And that happens every year. Brokers are allowed to officially market for that annual enrollment October 1st. Okay. We're not allowed to start enrolling until October 15th. But we're allowed to market and talk about the upcoming plan years. And that's why it's still a guesstimate. Okay. And every year, we can assume more and more things are going to happen with this Inflation Reduction Act as the years go by. This is the beginning of it. This is where it's first hitting Medicare. But again, the carriers are going to have to see what did that do this year? What adjustments do they need to make? Things like that to self-service that senior population. So with all of these choices, Metagap or advantage or premiums or increased

potential, all of that. What can seniors or people that have not started, you know, filing for Medicare, what can they do to prepare? Because these are costs that they have to be prepared for. And maybe you could be doing some things ahead of time just to prepare for that. What are some of those things that people should be thinking about? So it depends on where you're at your stage of life, okay, to start. starting your retirement investments young is very crucial.

I get it. When you're in your 20s, you're fresh out of college or trade school or the military, whatever life's path taking you, you don't want to start thinking about it. But you need to start preparing. Your best time to prepare is in your 20s to late 30s. You can be aggressive in the market. Your goal is to save up enough capital to ensure that you have a nice nest egg when it's time to retire. don't ever, best financial advice I can ever give somebody, don't ever go over the companies

match with your 401k. There are other investment tools that outperform what that 401k can do. So if your company match maximum is 3% and you've been putting 5% in, bring that percent, take the other 2% monthly and go put it in a different vessel. And we will be doing an upcoming, actually, we'll be. doing more of these podcasts and talking with you, where we're going to give better advice on that. In your 30s through your late 30s through your 50s, you want to start minimizing market volatility.

It means you don't want to be as aggressive. You had a long time to be aggressive and grow money. Now we want to start putting that into more safe investments. By the time you hit your late 50s and into your 60s, it's time to move that money into income growth type of programs. Therefore, now, we're now at retirement time, right? And what we want to do is move that into a product that gives lifetime income. Because we have that nesting there, right? Now these changes in Medicare will, it'll be a soften of the blow every time Medicare changes. When the prices go up, you did a great job as far as, you know, being able to make sure there was enough

in your nest egg. The other big question is, when do I finally take my Social Security check and actually retire? And that is a big question. And one of the books that we have on Social Security, you will be able to, you know, check that out and we'll answer those questions. But I'll give you a quick little sneak peek. The question only starts somewhere around the early 60s all the way up to 70. When do I take my retirement? Well, depending on your age, depends on the percentage of your full retirement benefit. At age 62, that's only 70% of your full retirement benefit. But if you wait until the age of 70, that's 124% of full retirement benefit.

So the best thing I can tell you is get with an advisor that understands that can help you go through that. Again, you can check out our Social Security book. We'd be more than happy to create a link to be able to get one of those. But knowing when to take that mixed in with how you put your investments towards your retirement is very, very crucial. Yeah, because if you do the right thing well ahead of time, then you are financially set to delay filing for the Social Security and get the highest possible. but if you wait too long, you might need the Social Security funds and you have to take that lower amount. So I think your points there are so well put together because people need to plan ahead. They need to get with someone like yourself that is an expert that can look at their situation,

give options. You're never going to force people into anything specific. It's just here's what your options are to help them make that great decision. So Paul, this has been really eye-opening for Medicare and planning. if someone is interested in learning a little bit more and then reaching out and connecting with you, what's the best way they can do that? Sure. So if you're looking for Medicare, we have two sites.

So we have Looking forMed.com. That is a general Medicare site that you can go through. It gives a lot of great information. If you are a veteran, we have veterans looking for Medicare.com because that has its own special little ins and outs, and we'll cover that at another time. And then if you would just want an overview or you couldn't remember those two sites, you can go to cKhealthcareadvisors.com. And from there, we have a menu of options letting you get information and be educated on many different points from Medicare to retirement to life insurance. And it goes well beyond that, Mike.

Excellent. Well, Paul, thank you so much for coming on today. It's been a real pleasure meeting with you. You as well. I appreciate it. You've been listening to Influential Entrepreneurs with Mike Saunders. To learn more about the resources mentioned on today's show or listen to past episodes, visit www.com.