Check out the latest edition of our newsletter!
Club MED
March 2023
Medicare Advantage Is NOT FREE
YOU MUST ACCOUNT FOR COPAYS
A comment I sometimes hear during my introductory Medicare meeting with clients disturbs me. “I’m in great health. I’ll do Medicare Advantage.” I think Medicare Advantage is excellent insurance, just like original Medicare with a Supplement and Part D. It is all excellent insurance for the right person who makes an informed decision based on the facts of their situation.
I was waiting for open enrollment to be over again this year before returning for a second try. I went with a different surgeon this time.
The introductory meeting with Dr. D was interesting. He described how he would “hammer the mesh down this time” so nothing would come loose. His description left me a little
squeamish, but I agreed with his sentiment. He got into more details about what he would do to my
innards than I cared to hear. He kept talking about cutting this, peeling back that, stuffing something somewhere. I was getting nauseous at his vivid descriptions. To distract him from the graphic images of my dissection, I asked why the first hernia surgery failed. Wrong question. He didn’t even take a breath but shifted to his approach and how it would be better. Instead of going from the bottom up, he said, he would go from the top down. He would stand me on my head, so everything fell forward.
The phrase “I’m in great health,” or “I never go to the doctor” is not a good reason to choose Medicare Advantage. The past does not guarantee the future.
You are first eligible for Medicare when you turn 65. Sixty-five is not an arbitrary number. The government doesn’t pull the number out of the sky. You are a different person at 65 than you were at 55, 35, and certainly 25. You may recall me saying in our meetings that the best car in the world needs repairs and overalls at 200,000 miles.
I’ve been running and lifting weights since I was 12. Granted, many of my surgeries over the years
I had an image of myself standing on my head in the surgery ward. I assumed he wasn’t joking.
are related to being hard on my body, and I have had a number of them. But none of us are immune to the effects of time and gravity on our bodies. I have had to go to the repair shop a lot. In the summer of 2021, I didn’t know what was happening to me when I was on a river cruise in France. It turns out it was a hernia. I held off doing anything until after Medicare open enrollment that year. However, the hernia was back within a few months of the operation. The surgery failed. I found out that there is a fairly high failure rate for hernia surgeries.
My shoulders were killing me when I got out of surgery and into recovery. The doctor had stood me upside down, as he said. My shoulders were strapped into a harness to keep me from sliding off the surgical table. Bev, my physical therapist-wife, had to work out the knots in the muscles for a week afterward. My shoulder muscles were more painful than the four incisions in my belly.
CONTINUED ON PAGE 3 ...
Medicare Insurance Made Easy
402-614-3389 • 1
INFLATION REDUCTION ACT AFFECTS MEDICARE PRESCRIPTIONS
BUT LOOK AT THE HIDDEN COSTS
Congress recently passed the Inflation Reduction Act into law. Parts of the law affect Medicare beneficiaries. The law empowers the Department of Health and Human Services (DHHS) to negotiate directly with drug companies on the price of medications. The power is not for all medications, only a limited number of high-priced medications many Medicare beneficiaries purchase. Government intervention in the marketplace to reduce drug costs for seniors on fixed and, in many cases, lower incomes sounds like a great idea. Who would not be for that? Pharmaceutical
the parts. The blender stops and starts, sputters, then fails.
Cuban’s CostPlusDrugs.com doesn’t cover Eliquis, Januvia, Jardiance, Victoza, Trajenta, Humira, etc. If he does work a deal with pharmaceutical companies on more of these high-price medications, he will help many people. The challenge is that these drugs are under patent protection, so there is no competition. The pharmaceutical company has a temporary monopoly, and these medications are far better than the cheaper alternatives. Pharmaceutical companies with this patent protection have little incentive to discount their medications. Even a government as powerful as the U.S. cannot suspend the laws of economics. When it attempts to do that, the long-term consequences are destructive to the average person. Remember, when the Iron Curtain lifted and the Berlin Wall fell, the difference between Western Germany and Eastern Germany was stark. They had the same people, the same land and resources, and the same cultural heritage, yet one was capitalist; the other was communist. One was rich and growing; the other was poor and trapped in a lower standard of living. Look at the Korean peninsula at night from space. North Korea is dark, except for a small light in Pyongyang’s capital. South of the 38th parallel, it is as bright as the U.S. Same people. Different systems. In the short term, you may see some lower prices on one of your expensive medications. In my opinion, the long- term effect may not be so noticeable, but the average citizen’s economic situation will be diminished.
In a genuinely free market, entrepreneurs see larger than normal profit margins. They are incentivized to enter that market because there is room to undercut the competition. Eventually, the competition compresses margins. Entrepreneurs stop entering the market because competitors squeezed out any big profits. Mark Cuban is an entrepreneur who is doing that. Cuban’s idea is simple. Order drugs online on his website CostPlusDrugs.com. You pay 15% over the manufacturer’s cost, $3 for pharmacy labor, and $5 for shipping. For example, Restatis (generic: Cyclosporine) for dry eye is expensive. Without insurance, it would cost over $550. With a discount card, like GoodRx, the drug costs $205 at Walgreens. Mark Cuban’s Cost Plus Drugs has Restatis/Cyclosporine at $72.76 from the manufacturer, $10.92 for the markup, $3 for pharmacy labor, and $5 for shipping. The total is $91.68, much less than $550 or even $205. On a Medicare Part D prescription drug plan, you pay the $505 deductible for Restatis. Then you have a $47 copay. Eventually, it will jump up to the Gap or “Donut Hole” price of $149. That does not include the monthly premium for the Medicare Part D prescription drug plan. That could range from $25–$80 per month. Cuban’s company would be far better in this case. Cuban is just getting started with his new drug company. Hopefully, his company will expand how many medications it covers. Currently, many common high- priced drugs still are not covered. Mark
companies make billions. They are charging too much, aren’t they?
In reality, governments have the power to kill companies and whole industries. They can impose price controls. But should they? Have governments imposed price controls in the past? We’re all old enough to remember the Soviet Union and the satellite countries of the Eastern Block. The Communist countries were plagued with constant shortages and long lines for simple things like bread. Why? Citizens had money. Why the long lines? The economic wing of the Soviet government met regularly to determine prices for products and services from the time of Lenin through Stalin down to the end of the Soviet Union under Gorbachev. In a free and competitive market system, prices are the signals that align everyone in that market into an efficient production system. When prices are artificially manipulated, the signal is gone. The economy doesn’t know what to do or what to prioritize. It is like an appliance without wires and circuits to connect
2 • OmahaInsuranceSolutions.com
Testimonial
... CONTINUED FROM COVER
Did he take any pictures during the operation? It would be funny to share photos in a surgeon-Facebook group of unusual things in the surgery theater. “Look at this guy. I stood him on his head!” After my shoulders, my midsection definitely felt as though he had “hammered” the mesh down. He didn’t want a second failed surgery, so he really did nail the mesh to my pelvic bone. My second hernia surgery was easily double the pain in recovery. Hydrocodone didn’t even touch it.
“Chris does an excellent job of listening to your
needs. He uses that information to help you choose the best plan out of many options. Very happy about all his help.” –Doug & Vicki K.
I’m six weeks from the operation and moving back into running and lifting weights. It is incredible how much strength you lose in a short period.
My point is simple. It is not “if” some medical problem will happen to you. It is “when,” “how often,” and “how severe.”
So, when clients tell me they are “healthy” or “never go to the doctor,” I say: That was then. This is now. You will be going when you go on Medicare at 65. There will be issues, and you can’t avoid the inevitable effects of time and gravity on your body and mind. I don’t say that to discourage anyone from considering or being on a Medicare Advantage plan. Still, it is naive to think you will pay the low monthly premiums and pay low copays, even a lot of copays. At some point, you will pay hundreds of dollars in copays. I guarantee. Some years, you may even pay thousands, so you need to understand that and be prepared. You can prepare by saving. When you have saved your maximum out-of- pocket amount, it is then that you have a level of “bulletproofness” from the inevitable financial effects of health care costs. When copays arise, your savings account will be your warm, comfortable security blanket. I have run and exercised regularly since I was 12. I never had any indication that I had a left-dominant heart. That means I have an artery in my heart that is inordinately small. I have always had it. I didn’t find that out until I was 56. Enough plaque had built up to clog the blood flow sufficiently to put me into cardiac arrest. You don’t know what’s in your body until it has been stressed by decades of wear and tear. A Medicare statistic that has always stuck in my mind is that 25% of the total Medicare expenditures each year is to pay for the last year of life. The average Medicare beneficiary is usually on Medicare for around 12 years, but 25% of the total Medicare budget goes to pay for the last year only. Incredible! I will only consider changing cars once I have driven them for 200,000 miles. I drive Toyotas, so they will run until Jesus returns. But even Toyotas need repairs, even serious repairs.
Apple Tart With Rosemary and Honey Syrup
Inspired by Delicious.com
Level up your dessert game with this unique apple tart! Covered in rosemary-infused honey, this recipe combines the sweet flavors of pink lady apples and the peppery depth of rosemary, all atop a flaky crust. Ingredients • Frozen puff pastry, thawed • 3 1/2 tbsp unsalted butter, softened • 1 egg yolk • 1/3 cup almond meal • 1 tsp vanilla bean paste • 3/4 cup runny honey, divided • 2 pink lady apples, very thinly sliced • 1 rosemary sprig, leaves picked Directions 1. Preheat oven to 400 F. 2. Roll pastry to a 12-inch-diameter circle, 1/8 inch thick. Place on a tray lined with baking paper. 3. In a bowl, place butter, egg yolk, almond meal, vanilla, and 1/4 cup honey. Beat with a wooden spoon until smooth. 4. Spread over pastry and arrange apple slices on top. Drizzle with 1/4 cup honey. Bake for 20 minutes, until golden and crisp. 5. In a pan over low heat, place rosemary and remaining 1/4 cup honey. Swirl to melt honey. Pour over tart, and enjoy!
Don’t fool yourself that you will not have copays on Medicare Advantage in the future. No matter how healthy you have been and are now, you will.
–Christopher J. Grimmond
402-614-3389 • 3
11414 W. Center Rd., Suite 250 Omaha, NE 68144 402-614-3389 OmahaInsuranceSolutions.com
PRSRT STD US POSTAGE PAID BOISE, ID PERMIT 411
Code 72385_022323_MK
INSIDE This Issue
Please Consider the Effects of Time and Gravity
1
2
Good Law, Bad Economic Policy?
3
Testimonial
Apple Tart With Rosemary and Honey Syrup
3
4
Properly Fuel Your Body
It’s All About Healthy Aging!
Fueling Your Body in Your 50s and 60s
50th birthdays are often filled with mixed feelings about aging, wisdom, experiences, and pride. Many are thrilled to be close to retirement, becoming grandparents, and entering a new stage of life. However, as we age, our bodies change, and it’s essential to focus on properly nourishing that changing body. Here are some dietary tips to ensure your body gets all the nutrition it needs to flourish and thrive in your 50s and 60s!
soy products are chock-full of calcium, a critical nutrient that supports bone development and health.
DON’T SKIMP OUT ON FISH. Chronic diseases such as dementia, strokes, heart disease, and diabetes become more common in our later years. Healthy omega-3 fatty acids are essential to combat these issues and reduce inflammation in our bodies. Fish is high in these nutrients, but if you aren’t a fan of fish, you can also find these healthy
STICK TO WHOLE FOODS. Processed foods, which are linked to weight gain, health
complications, and heart disease, are usually high in sodium, saturated fats, and calories and lack beneficial nutrients, vitamins, and minerals.
fats in walnuts, chia seeds, hemp seeds, and supplements. Best of all, omega-3 fatty acids are proven to lower the rate of mental deterioration! INCLUDE CALCIUM. As we age, our bones become increasingly prone to osteoporosis, a decrease in bone mass. High-calcium foods such as milk, yogurt, cheese, leafy greens, and
Opt for fresh and frozen vegetables, whole grains, meats, and healthy fats to promote optimal health. OPT FOR WATER. Sugary drinks and juices wreak havoc on your waistline and can lead to diabetes and other health conditions. Water is the best way to maintain hydration and fuel your body’s daily functions properly!
CONSUME AMPLE PROTEIN. Protein is vital for building and
maintaining lean muscle mass, which supports metabolism, boosts immunity, and keeps your body strong. While lean meats, fish, and poultry are excellent protein sources, remember that protein is also present in eggs, tofu, lentils, beans, seeds, nuts, and dairy products.
4 • OmahaInsuranceSolutions.com
Page 1 Page 2 Page 3 Page 4Made with FlippingBook Ebook Creator