Ron Walton: The MedicareXpert

March 11, 2020

 

 

 

Alan  
Can you tell us a little about our background?

Ron  
I spent over 30 years in long term care and assisted living facilities. I worked for Sutter Health for a number of years, I've run transitional care centers as a chief operating officer for nine skilled nursing and three assisted living facilities. So I've had a wide background in in long term care and healthcare.

Alan  
What is it Chief Operating Officer do?

Alan  
I acquired facilities I had over 900 employees that we managed, making sure they have the right benefits, retaining people, training people, hiring administrators to run our facilities,

Alan  
Were you will you growing during this time?

Unknown Speaker  
We acquired three, three assisted livings and in Maryland we acquired a skilled assisted living combination facility.

Alan  
It must be kind of hard combining businesses together like that.

Unknown Speaker  
Well, actually, there's synergy because you have the assisted living they're and either more independent, have their own apartments with needing lesser care, but as they progress and need more care then they could go into the skilled nursing, and vice versa, if someone broke hip, they could then go back to their apartment once they were rehabbed and enabled to return to the lower level.

Alan  
So coming out of school, did you always know that you are going to be the Chief Operating Officer? How did you how did you progress to get to that point?

Ron  
I was in Business Administration and three of my best friends wanted to become CPAs like you. And I said, No, I really like working with people. So There was a new program in Health Administration, and everything I'd taken so far transferred into that. And so I earned my bachelor's and Health Administration. And then I went on to earn a MBA through Golden Gate University in Health Administration. I then became as an assistant administrator in a skilled nursing facility, I went through the training to become an administrator. It takes 2000 hours, you have to go through 2000 hours and pass a state and national exam to become a nursing home administrator.

Alan  
So you're certified then.

Ron  
I'm a licensed nursing administrator.

Alan  
And when a name when you did that, you mentioned Maryland, did you do everything in the same state? Did you move around?

Ron  
I actually began in the Napa Valley. And then I moved down to the Monterey area. The company I worked for just happened to have most of their facilities in California, but they built a brand new facility in Maryland, and then we acquired a facility in Maryland.

Alan  
Does that certification transfer over to different states or do you have to re-certify?

Ron  
I wasn't actually running the facilities. So we hired administrators that would run those facilities who are licensed in Maryland.

Alan  
In looking at the landscape of changes and we've seen the Obamacare than the reversal and you know, the whole healthcare industry, what do you see things going right now?

Ron  
All I know in healthcare is it's always changing. You know, I used to say, it can't get any worse and every year it became more complicated and more difficult to run. Health care the cost are out of control. We need to find some way to provide care at lower cost levels. I worked Sutter for 10 years. I ran their Transitional Care Center up in Sacramento. And that was, you know, their mantra, how do we continue to lower cost and cost of just continue to go up?

Alan  
At the same time, we're looking at cost reduction. We're also looking at an influx of baby boomers coming into the system.

Ron  
Yeah, there's actually 10,000 turning 65 every day in the United States. So the baby boomers are going to have a huge impact on health care. In fact, about 80% of the dollars are spent on people in their last two years of life.

Alan  
So first of all, what is Medicare and why should we care about it?

Ron  
Well, it's a hot topic right now, you know, they're talking about Medicare for all. And so it's amazing that Medicare is for those over 65. But it's the most complicated health plan out there. You have your Medicare A, B, C, and D. You have plans A through N, and so most seniors when they get to that point they have no clue. What do I do? There's Medicare supplements, there's Medicare Advantage plans out there that are run by private insurance companies. So Medicare, if you've worked over 40 quarters in and paid in taxes for over 40 quarters, you qualify for Medicare Part A. So there is no premium for Medicare Part A. Medicare Part A covers your hospital services, skilled nursing and home care. And then we have what's called Medicare be and Medicare be you pay a premium, a monthly premium. And that can range from $144 all the way up to just under $500 depending on how much money you make. And so that's for your doctors, your lab, your X ray. So it's anything outside the hospital, and then you have what's called Part D, which is for your prescription drugs. And then there's Part C, which is the Advantage plans and that's where the government contracts with insurance companies. They manage your part A, B, and C. So that's where you need to find an expert who can actually talk to you about Medicare and find plans at work, not only for your budget, but also what are your health needs? What type of medications are you on? What type of health issues do you have? And then we can find and locate plans that work best for those individuals.

Alan  
So if you're a Over 65, you want to really drop the other plans and let's go on Medicare, or should we go to you first?

Ron  
I would talk to an expert, someone who knows the ins and outs of Medicare. The pricing is based on geographic areas, the government has set the plan. So like a Plan G or Plan F that you'll hear about, those are all the same plans, but the your price range can range from- for example, I just turned 65. I got a plan that was 117 a month. But I could have paid $300 a month for the same plan, but it would have been with a different insurance company. So that's the advantage of going with an independent broker who represents all the major companies that are in the area. And then you can find the plans that best meet your needs.

Alan  
And Medicare, I have to pay into that right?

Ron  
You have to work your 40 quarters or basically 10 years and have paid taxes into the system.

Alan  
Doesn't matter how much tax I paid?

Ron  
No

Alan  
So for somebody's getting ready to retire, that don't retire until you've worked 40 quarters before you reach 65.

Ron  
Or you can if you work 30 quarters but you're gonna have to pay a premium, and it's about $300 a month. So you want to reach your 40 quarters. So part A is free, part B, you do pay a monthly premium on that. And that goes up every year. As well as the part D.

Alan  
There are some provisions for some individuals not 65 that can draw on medicare, What are those circumstances?

Ron  
Those are people with end stage renal disease and people on disability. So if you're on disability, you can also qualify for Medicare if you've been disabled for over 24 months.

Alan  
Now, there is some misunderstandings about what Medicare provides for and what they don't provide for what is the biggest misunderstanding

Ron  
The biggest misunderstanding is that Medicare will pay for long term care. I had a lot of people come to my facilities thinking hey, Medicare gives me 100 days of coverage and they find out that only when they're on skilled coverage. Which would be IVs, receiving physical therapy, they get, they could actually get those days. So, yes, you can get up to 100 days, but many people only get a few weeks. And then after that it's all out of pocket. And a lot of people are surprised at the cost of long term care. Here in San Francisco or San Jose, to be in a skilled nursing facility, it's running about $130,000 a year. And if you want a private room, it's about $150,000 a year. So you can see how quickly people can drain down their assets. People work all their life to to put money aside and build this nest egg to retire off of. And if you have someone in a nursing home for three years, which is the average, that's almost half a million dollars. And what people don't realize is 70% of all people over 65 are going to need some type of long term care in the future. Now most I want to go into a nursing home. So fortunately, there are a lot of us options, there's assisted living now, we have some adult daycare centers. And then you can actually have people come in and provide either chore workers or some type of a CNA or nurse who can provide four hours, five hours, whatever you might need in a day. But that's running around 50 to 60,000 a year to have a chore worker come in and take care of you. If you want to nurse it's going to be closer to$80,000-$90,000.

Alan  
From a family standpoint, often with aging parents, you never know the right time, or how you do this. We go through life once and you suddenly realize that mom or dad can't take care of themselves. What advice would you have for them? Who do they need to consult?

Ron  
Great question. You know, I worked in nursing homes. I don't want to spend the last days of my life in the nursing home, if I need to, that's great. But I'd like to keep people on the in their homes as long as possible. So this needs to be like you said, a family decision. You need to sit down and talk to your family. How are we going to do this? The first thing I recommend is you need a plan. What is your plan? If you have a spouse or children that are willing to provide care for you? Great, but that's a rarity nowadays. My children live in five different states, I only have one that's in the state. So I can't rely on my, my children. And then a lot of spouses say well, I'll take care of my my husband Well, okay, so you're in your 80's have your spouse lay down on the floor and get them up off the floor. My father in law had that issue, his wife fell, he couldn't get her up off the floor, and that's when they decided, hey, we can't stay in her home any longer. So they both moved into an assisted living until he passed. He was there about a year and a half and she's still there. It's been about five years now that she's been in an assisted living facility. So an assisted living facility is gonna run around. $75,000 a year here in the Bay Area, if you move to other parts of the state like Sacramento, where she's at, it's going to be around $50,000-$60,000 a year. So there's things to consider, you know, you can actually go to different states that are cheaper, closer to your family, and a lot of times they're than here in the Bay Area. So you need a plan. There are a lot of options out there.

Alan  
How does a the person contact you for more information on your services?

Ron  
I have a website which is TheMedicareXpert.com, also my phone number is 510-894-3137.

Alan  
Can you walk me through your process  on how you woul advise me on an insurance program?

Ron  
I'm an independent broker. So I work for my clients. I don't work for a company. I represent the major companies and that's what I do. I pick the top companies the best coverage and so we find out about you. What is it you're looking for? What do you need? How do we best meet those needs for you, you may have some health issues, you may have some prescription drugs you're on. And we can actually type that into my computer programs, and it tells me what's available in your geographic area. And then what gives you the best coverages. We also look to see what doctors you use. And we try to keep your doctors and include those in programs that will cover the your doctor. So you can stay with your current physicians. So that's how I work. My services are free to do an evaluation for those looking to get on Medicare. And, you know, there's certain windows and time frames that you need to be aware of to make sure you're, you're taking advantage of those. Same with long term care. There are windows when it's best to get long term care. And that is when you're young, and when you're healthy, because when you're no longer healthy, I can't get you covered. So there's kind of a sweet spot which is between 50 to 65. That are the best times to apply for long term care coverage. There are actually three different types of coverage Now, what is the traditional long term care, which is like your auto policies or your home policies, it's a pay as you go. But it's a use it or lose it type plan. We have other plans that are linked to life insurance products. And that gives you a death benefit. But it also gives you a living benefit. So if you have a cancer, stroke, you need to go into a skilled nursing facility, you can draw down some of those funds and use that to prepare to pay for your care. And then there's what's called a hybrid plan and the hybrid plans is built also on long term care and annuity plans. And basically, if you have $100,000, you want to put down for care, it'll give you a multiplier of that. So you can maybe get $300,000 that's available for care in the future. And it's all based on age, health and those type of things. So the healthier you are, the younger you are, the better coverage I can get you.

Alan  
What about MediCal, did you deal with that?

Ron  
I did as an administrator, because 70% of my population was on MediCal. The problem with MediCal, it's you have to be impoverished, you basically have to spend down your assets, you can't have more than $2,000 in your account. And you have what's called share of costs that you pay every month. So if you're getting a Social Security income or a pension that goes first and you get $35 for your incidentals. So basically, not only does it limit the types of care you can get, the only one that will provide care right now is your nursing homes and there is some in home support services. But it limits the type of facilities you can go to. Assisted living is all private pay so or you need some type of insurance to cover that. So if you want the type of care you want, if you want the level of care you want or the facility you want, it's best to plan now and have some plan in place. The other thing with MediCal is that the They can actually go back after you pass away, and they can attach and take the money back from your home. And there's actually some states that are actually going after their children to pay for the care for their their parents. So as more and more states get into trouble, because a lot of them are having trouble funding Medicaid in their states, they're going to be looking for ways to take some of that money back. And so my recommendation is, it's best to have a plan. My mother always used to say if you fail to plan, you plan to fail. And the last thing you want to do and when you get to that point is limit your options and or not have any options.

Alan  
One more time, how does a the person contact you for more information?

Ron  
TheMedicareXpert.com or give me a call at 510-894-3137.

Transcribed by https://otter.ai

 

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