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The Next Big Thing in Health is a podcast where we explore the new big ideas that will help make health care more affordable, more available, and more effective.

ÐÜèÊÓƵPresident and CEO Matt Eyles and co-host Laura Evans sat down with four seniors — Corrin Heck, Sandy Smith, Vicki Benson, and Mike Vaquer — to discuss the value and benefits of the Medicare Advantage program.

Eyles:

Hi, everyone, and welcome to the Next Big Thing in Health, a podcast from AHIP. I'm one of your hosts, Matt Eyles.

Evans:

And I'm Laura Evans.

Eyles:

More often than not on this podcast, we're talking to health experts plan CEOs and policymakers about how to set and execute health policy and the ways in which our industry can make health outcomes better for people. On today's special episode, though, we get to talk to some of those people, and I'm really excited about it. We're going to talk about the importance of Medicare Advantage coverage with people who have MA. Medicare Advantage provides coverage for more than 30 million Americans, giving them access to reliable health care, and a whole range of benefits that traditional Medicare doesn't offer, such as vision, hearing, dental benefits, wellness programs, in-home caregiver support, and protection from high out-of-pocket costs.

Evans:

So welcome to you all. Thank you so much for joining us today. And just to start us off, could each of you introduce yourselves and offer a brief bit about your background and where you're from. Sandy, why don't we start with you?

Smith:

First of all, I'd like to thank you for this opportunity to share my experiences. My name is Sandy Smith, and I live in Wyoming, Michigan, right outside of Grand Rapids. And I have my background with health organization I used to work for. And I've been real active politically, as well as UAW. So any of the topics that are near and dear to me, where whatever circle I'm in, I've always been very vocal, and making sure that I express how I feel about what it means to me. And I take it by, look forward to this discussion among everybody. Seeing that I'm not the only one that feels like this is really good for us. And I hate to think of it going away.

Evans:

Vicki?

Benson:

My name is Vicki Benson. I'm a retired multi-line insurance agent. I'm here in sunny Scottsdale, Arizona, and I have been involved in helping my own clients understand Medicare, Medicare supplement insurance, Part D insurance. When Part D first came out, I had all my retired clients who needed help come in to me and I help them search for the best plan, even if it wasn't something I could offer them. And it was a daunting task having to know every drug they took and guess what they might need in the future in order to to figure out what in the world they should sign up for. And at that point, I really was aware that when my day came to be able to be on Medicare, that the plan I would go for would be a Medicare Advantage plan. I don't have to try to guess what my health will be in the future. I know that I'm going to be in good shape, and I am real pleased to be included in this opportunity to talk about the benefits of it.

Evans:

Thank you, Vicki. Corrin?

Keck:

Hi, my name is Corrin Keck, I'm from Reno, Nevada. I am a more or less retired advertising executive. I had an advertising agency for quite a while, sold television before that. But now I'm working part time as an insurance agent, primarily commercial and personal lines. So I haven't really sold health insurance. But my first year on Medicare, I did have a supplement. And it was very daunting, I have to say because I still had the Part D to pay for as well as the premium and it just was nowhere near as versatile for me or as expansive as far as health goes as my Medicare Advantage plan because now I have so many more options. Not only just doctor visits, but gym memberships and hearing and vision and dental. And it's just a lot more of an asset for me than a Medicare supplement would ever be. And I enjoy skiing and outdoors living close to Tahoe. Can't help but want to get out in the wilderness and have some fun and so being able to stay healthy and get the care I need is really important to me.

Evans:

And you're getting a lot of skiing in this year with all that snow.

Keck:

I'm headed up there shortly.

Evans:

All right, and finally Mike, can you introduce yourself a little bit and tell us where you're from?

Vaquer:

Sure, I'm Mike Vaquer. I live in Savannah, Georgia. I am a retiree from the pulp and paper industry as a government affairs manager. And currently we have our own small boutique government affairs firm that primarily represents local associations and local governments. And we have been a member of Medicare Advantage since right after I was eligible for benefits and realize that all I had was my Medicare card, and it was quite a shock when I went to get my first prescription. So immediately made a run to get signed up for Medicare Advantage, which has been a great benefit since.

Evans:

Wonderful.

Eyles:

That's great. Well, thank you so much for joining us. Have you here today, and we can jump right in. And some of you have touched on this first question a little bit. But I'd love to hear just to start about your experience enrolling in Medicare Advantage and, and what led you all to enroll in Medicare Advantage? And maybe Sandy, we'll start with you.

Smith:

Yes, well I've been retired two years, and I remember when I was looking at benefits and thinking of what's going to happen with my medical care, because I have pre-existing conditions. And I wanted to make sure that I was going to have something that is going to take care of my medications, take care of my office visits, and anything that could come up. And when I looked at and did the comparison, Medicare Advantage was the best thing for me, knowing that I only pay that $10 copay, I keep it moving, my prescriptions are affordable. And I don't worry about it. And I've talked to others that they're concerned because of their medications, they can't afford this they can't afford that. And like I told you Medicare Advantage, I have not had to worry about that. And that's really been a blessing. And it's reassurance for me. And one of the other things I like about Medicare Advantage, my and they remind me when I need to go for a physical when I need to go for colonoscopy. Yep. And then when I need my mammogram or anything, because we get so busy, a lot of times we forget about how long it's been since we've had these things. But one thing I do value about them, they remind, and I thank them for that. And I really appreciate it. And I just hate to think of them doing away with Medicare Advantage or watering it down, because it's going to really impact a lot of us. So I'm thankful that we have opportunity to speak on it. And I hope they're listening. And they will listen to our stories and see the advantage of Medicare Advantage.

Eyles:

That's great. Keep it moving. And I like the reminders too, Sandy. Yes, that's really, really important. Corrin, how about you?

Keck:

You know, I was fortunate that somebody called me and talked to me about Medicare Advantage plan because I had a broker, and he's a good friend, and he's great guy. But all he sold was supplements. And he didn't really I don't think understand the advantages of Medicare Advantage plans, or else he just wasn't appointed. I'm not sure which. But he did complain about how little he got paid for health insurance for commission at this time. So I knew it wasn't a big loss for him. And I was able to enroll in Medicare Advantage plan several years ago, I think it was, I've been on it for a couple years. And I have seen a huge difference in my approach to health. I think I am no longer afraid to go to the dentist or afraid to go to the doctor's office or afraid to find out what's going on if I feel like something's wrong, because my Medicare Advantage plan has such low copays, and such great coverage that I've been able to get two hip replacements as well as the care afterwards, physical therapy, home care when I needed it. So many things that I just was never aware of with Medicare supplement. And I know if I was just on Medicare itself, I'd have a huge quarter that I'd be responsible for. So I'm just really grateful that I got that phone call from somebody cold called me.

Eyles:

Wow, two hips and you're still skiing. That's amazing, Corrin. That's incredible. Mike, how about you?

Vaquer:

Well, as I said, I turned 65 and my Medicare card showed up and I thought fantastic this is going to be wonderful. Went for my regular annual physical, the doctor said all is good, here's your prescription for your blood pressure medicine. Fine. I roll into the local Walgreens and handed the prescription and handed them my Medicare card. And they come back and say this will be x amount of money and I said "huh, what do you mean? I'm on Medicare." They said, "Well, you don't have Part C, or Part D," whatever it is, that covers prescriptions. I said, "I don't read the fine print. I didn't read any of the fine print." Fortunately, I was within the open enrollment period. So it was able to get in and was educated on the Advantage plan and very quickly rectified that. It was a little frightening to begin with, because I thought, Okay, I'm supposed to have this benefit. But what in the heck does this mean? How complicated can this be? The agent walked me through it expand within maybe a month or so I was ready to go. And fortunately, I had enough medicine to get me through that period of time.

Eyles:

Wow, that's a good, that's great story that you were able to get in even being in the open enrollment period. ÐÜèÊÓƵ you, Vicki?

Benson:

Well, as I said earlier, as an agent, Corrin was talking about why the agent only sold Medicare supplement I had, that was the only thing available in my agency that I could sell. So I didn't have a choice. But I knew very well, by the time I had helped people with that, who came and said, This is what I want. Then at that point, I would show them what the plan was that I had. But I think the final straw was when Part D came, it was such a relief to people to find out that they would have protection to cover medications. But when they saw the complexity of that program, it wasn't the gift that everyone thought it was going to be. And it changed every year, what would what each company would cover and not cover. I never, all the years of selling insurance, I'd never seen a plan that could change their mind every year about what they would cover. Medicare Advantage, that isn't the issue, all you focus on is getting well. If you're not well, if you're injured, if you're going to have surgery, whatever it is, your focus is totally on the other side of the bridge. When you get your treatments done, you get your medication, and you begin to feel better, or you quit getting worse, whatever your fortunes are, but you're never laying awake at night worrying about now what, what are we going to do? That isn't a question on the table. And that is a true gift for everyone's mental well-being as well as their physical well-being.

Evans:

Well, that's certainly his peace of mind, Vicki. And that speaks volumes and really is an indication of this, this study that came out of the Coalition for Medicare Choices that found that 94% of senior voters say they are satisfied with the coverage and care they receive through their Medicare Advantage plans. And I would say that all four of you fall into that category as well. I'm curious how you feel about the choices of doctors and hospitals that you get through the plan. Vicki, let's let's start with you.

Benson:

Well, the plan I'm on if I'm needing care in a field that I haven't gotten care, you know I have my own doctor. In fact, my doctor retired recently. And so I'm kind of in between, I haven't had cause to go back. So I will call for an appointment for an annual, they will give me someone, I will meet with that person. If I'm not thrilled with that person, I can call again and say, "next time I want someone else." Now I'm 72. So in the years since I turned 65, I have never not liked the doctor that I that they have said, "This is who you need to see," I had a hip replacement in the middle of COVID. Every single doctor along the way that I dealt with was wonderful. They're all always very accessible location-wise, it's not a horrible drive to get there. A hospital is very close. Again, all of the things that you look at and hope that's the way it's going to be, that's the way it is. That's why it's always been. I have been totally happy. And I think again, it's that peace of mind in knowing I meet this person and I just don't really care for them. I don't have to go back again. I don't have to explain it. I just call and say "next time find me someone new." No problem.

Evans:

Thank you. Thank you and Sandy, have you had similar experience? Are you happy with the choice of doctors and hospitals?

Smith:

Yes, fortunately, my doctor is in the network. So that made it really transparent. When I went over into Medicare, I didn't have to worry about who am I going to select for a primary doctor. And anytime he's had to refer me, it's been somebody that I trust his judgment in referring me. And so I've had success with all the doctors that I've dealt with. And like I said, having my primary that made it really satisfying, and put my mind at ease, knowing that I don't have to worry about switching and getting a doctor that's going to have to be familiar with me.

Evans:

And Mike, have you had any experiences where you've wanted to see a certain doctor, but they haven't been in this network?

Vaquer:

I have not. We've been very fortunate, my doctors have been fairly static and extremely good. In fact, the cardiologist to install my pacemaker was one of the residents at Washington Hospital that treated President Reagan when he was shot. My wife has a genetic liver disorder, and she has gone to five, six, seven, or eight different doctors that she has selected, including a couple at Emory in Atlanta. And so we've had no problems whatsoever in getting the doctors that we need and the quality of care that we need, with no questions asked.

Evans:

Right? Corrin, let's hear from you on this one, too. What do you think?

Keck:

Well I'm not sure if my area is just extremely flexible, or if all areas are the same. But I know my surgeon practices at several different hospitals. So even if I was to change plans, which I did recently, I don't have to worry about not having that particular provider. But recently, I changed primary care providers, I was disappointed with the one that I had, I just didn't have the same philosophy I did about health. And I was at so what I did is I asked around, I was actually recovering from a hip replacement. So I talked to nurses and other people that were coming around, and they recommended this one doctor. And sure enough, he was in the network. So I had no problem with changing, it was a very smooth transition. I have not had any issues with trying to fit a doctor into the program. It's always been somebody that I wanted, my choice, and they accepted my plan.

Eyles:

That's terrific, and so many good stories that you've just been able to share about that. We do know, though that the past couple of years have definitely been a bit challenging as we've navigated COVID and working through the pandemic, I think it's been challenging for all of us whether it's, you know, physically, mentally, financially. During the pandemic, did you find that your Medicare Advantage plan helped you in accessing the care that you needed? I know, Vicki, you mentioned getting a hip replacement during COVID. That's pretty impressive. But maybe, Mike, maybe you could answer this question just to see, you know, how it's helped you in accessing the care that you've needed, maybe during the pandemic especially?

Vaquer:

Well, it particularly helped me in very early on exposure to an individual who had COVID, which required me to sequester for about three weeks, which was the time it took to get a COVID test processed. Fortunately, I had a physician friend who was able to make available one of five tests here in Savannah, I called him and he said, "Get in your car and start driving to me." I got there, they met me in the parking lot and gave me the test. And then I said "I'm going to Atlanta, because I'm not going to contaminate my family." And as I said, I spent the next three weeks that was the ease and the confidence with having this not having to worry about number one, having access to the test, but also having access to the actual doctor himself, who I could call on a three or four day basis, because he would check in on me and say, "Do you have any symptoms? How are you? How do you feel?" Fortunately, knock on wood, I had no symptoms and had nothing negative during that entire ordeal. But that gave me significant peace of mind during that pandemic.

Eyles:

That's a great story. How about you, Corrin?

Keck:

I was fortunate enough to have tele-doctor coverage. So I didn't have to go out when I did get sick. I had COVID, and I was able to have groceries delivered and things like that. But the Teladoc was a huge relief because they were able to call in prescriptions, and somebody picked them up for me, and it was just pretty easy to get through it without having to go to a doctor's office because they didn't want to see you anyway. So yeah, I was really fortunate and I think the Teladoc is a real benefit. It's a benefit all the way around, because sometimes you just can't get out, and it's really difficult to talk to a doctor. And but if they can come to you on your computer and take care of the problem, it's great.

Eyles:

There's one last question that we usually ask all of our guests, and that is, what is the next big thing in health? But today, we're going to put a little twist on it and ask you, what's the most important thing for your health? And maybe Sandy, I'll start with you.

Smith:

The most important thing for me for my health is the maintenance and that I'm able to maintain the continuing maintenance to keep me healthy. Like I said, I do have underlying existing conditions, but because of the maintenance and being able to go through my regular exams and the medications, it's keeping me where I feel good. And I feel like I'm healthy even though I know I've got a few little things going on. But it makes me feel like they're being addressed, and it gives me the peace of mind that I'm able to go ahead and just enjoy this retirement.

Eyles:

That's great. Corrin, how about you and your adorable four-legged friend that you have with you?

Keck:

Well, being able to take care of myself is a really big part of it. And having the confidence that there's people out there to work with me, there's resources available to me. I have an issue right now with my shoulder, all I had to do is re-contact the doctor that x-rayed it last year and said, "yeah, that's, you know, could use some work." And I'm going in Monday, I mean, they seem to accept my program, I don't see any hesitation on their part, to get me into the office and take care of me. And I have no hesitation in getting into their offices to take care of me. So I think it's a two-way street and just having that that confidence that I can go to the doctor, I can go to the dentist, I can get my eyes checked, I can check my hearing, so that my overall health, and I can go to the gym. So just all in general, just having access to health care.

Eyles:

That access is so important, Mike, how about you?

Vaquer:

Well, I think maintenance and access is critical. I am a in-remission bladder cancer patient. I now go in twice a year for cystoscopy and twice a year for BCG treatments that make sure that the cancer does not come back. That is not monitored remotely, I have to go into the office for that. My pacemaker is monitored remotely, it communicates almost on a daily basis with physicians. And when I do go and lay down information, look at it and I have about a 10 minute session with cardiologist, which in some instances that possibly will be translated into a pure telemedicine is because a lot of that is basically just sitting and chatting for a few minutes, because he has all of the data in his hands that he needs. In addition, I also monitor my blood pressure on a regular basis, and they have access to those records. So there are going to be innovations in health care that are going to somewhat replace some of the normal well-visit trips that you have to take to your physician to make sure that you're doing all right. Because who knows best how you feel than you and how you were doing?

Eyles:

Yeah, it's amazing some of the innovations. Thanks for highlighting that, and I'm so glad to hear that your bladder cancers in remission, that's really, really good. Vicki, you get to bring us home with some final thoughts.

Benson:

Well, everyone has really touched on every point from the beginning to the end of what has to do with the well-being of seniors, who I would like to point out, I'm sure they will agree, we do not like to hear Medicare be referred to as a entitlement. Every one of us has worked all of our lives and we have paid taxes, as a business owner, I paid the matching on my employees, I paid both sides of the tax. And it is not an entitlement. We have worked most of us, I would guess since we were teenagers, and we have put our time in and now we have the joy of living long enough to be retired. And this is not a gift you're giving us, this as an affirmation that we now are going to be able to enjoy our retirement and have the care we need so that it is a long, mentally and physically healthy life that we live and all the parts and pieces of a maintenance program that looks after us and calls us on those days when we haven't been in and make sure that there's someone on the other end of the phone when we call and say I'm not well. That is so important to our mental well-being. And that is what Medicare Advantage means to every single one of us who's enrolled in this program. And the truth is there are probably many who are not, who over time will keep moving to it because, ultimately, friends or family will tell them you're missing out. You're not getting all the benefits that you could get to protect your life and well-being.

Evans:

Well, Vicki, thank you so much Sandy, Corrin, and Mike. We really appreciate you sharing your personal stories and shedding some insight on Medicare Advantage plans. Thank you so much.

The Next Big Thing in Health

In each episode, ÐÜèÊÓƵis joined by a health care leader who shines a light on the big thing they want to see America focus on for health care improvement—from the impact of new technology like artificial intelligence to innovative solutions to effectively serve consumers.